Freiberg's disease an osteochondrosis affecting the toes: the articular surfaces of the second or third metatarsal heads collapse. It is commonest in girls aged 12-15 years. It causes pain on weight bearing and restricts physical activity. This entails removing fragments of articular cartilage and resection the dorsal aspect of the metatarsal head, to allow the joint to move freely and painlessly. Early signs of this condition will show a rarefaction of the metaphysic with sclerosis of the epiphysis. The distal end of the affected metatarsal is flattened, the shaft is hypertrophied and the head may appear somewhat fragmented.
Of all the osteochondroses, Freiberg disease is tiled to be the fourth most common, surpass by Köhler disease of the tarsal navicular, Panner disease of the capitellum, and Sever disease of the calcaneus. Radiographic changes among the osteochondroses are alike, regardless of location; they show subchondral collapse and fragmentation of the joint surface. Although considered to represent an interruption of normal growth processes, the specific events or factors that incite the cascade leading to articular collapse are unclear. Treatment should involve reducing stress on the metatarsal.
Rest and use of a metatarsal pad are usually sufficient treatment, but surgery is sometimes necessary. If extensive osteophytic changes result and deform the affected metatarsal, it can also impinge on and affect the adjacent metatarsal. Surgical intervention may be necessary to remodel the joint. Surgery should aim to keep the metatarsal parabola intact to avoid transfer lesions. Surgical procedures for Freiberg's disease include debridement of the metatarsal with removal of loose bodies, dorsiflexion osteotomy of the distal metatarsal and shortening osteotomy of the metatarsal.
Padding of varying degrees can help to balance or eliminate stress under the affected metatarsal. Early in the disease process, short term immobilization in a plaster cast is indicated. In later stages, a metatarsal pad or bar inserted proximal to the MTP joint may be utilized. This should be continued during athletic activities until the epiphysis closes. Total small joint arthroplasty utilizing silicone prosthesis also has been described for the treatment of Freiberg disease. Potential complications are similar to those for resection arthroplasty; other potential problems, inherent in the implants themselves, include synovitis, infection, and dislocation.
