Fact-sheet: Freiberg disease
Updated on 06/23/2020 at 9:18 AM
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Definition
Freiberg disease is an aseptic osteonecrosis, most often affecting the head of the 2nd metatarsal but which may also involve the 3rd metatarsal.
This condition most often affects young women (onset in adolescence).
Etiology:
- microtrauma to the metaphysis and growth plate leading to necrosis followed by flattening of the metatarsal head.
Clinical features
Pain predominantly felt in the weight-bearing forefoot at the second metatarsal head, particularly during push-off or when wearing high-heeled shoes.
The metatarsophalangeal joint may also be swollen and exhibit painful limitation of passive range of motion.
Radiography
- Epiphyseal fissuring
- Sclerosis of the metatarsal head
- Flattening of the head
- Deformity of the head
- Joint space narrowing - osteoarthritis
MRI
T2 FAT SAT:
- Edema involving the metatarsal head, hyperintense on T2
- Serpiginous hypointense line extending from cortex to cortex, +/- associated with subchondral plate collapse
Management
At the early stage, simple orthopedic management may be proposed, with immobilization and corticosteroid injection, but in case of failure or advanced stage, dorsiflexion osteotomy (Gauthier) is the reference conservative treatment.
Classification
Smillie classification:
- Stage I: epiphyseal fissuring with bone sclerosis
- Stage II: dense appearance of the metatarsal head
- Stage III: progressive collapse of the metatarsal head
- Stage IV: formation and release of loose body
- Stage V: marked deformity of the head with osteoarthritis