Freiberg’s Disease is caused by avascular necrosis of the
head of the 2nd metatarsal. This condition is more common in
patients who have a longer 2nd metatarsal bone relative to the 1st
metatarsal. This leads to the transfer of excessive loads onto the 2nd
metatarsal, which may interfere with the blood supply. This disease tends to
occur more commonly in young females during growth spurts. 
Freiberg’s Disease usually presents itself as pain and
swelling at the 2nd metatarsophalangeal joint that is related to
activities and walking in high heels. There may be point tenderness and
swelling over the head of the 2nd metatarsal. There may also be
limited range of motion in the 2nd metatarsophalangeal joint. Early
in the disease, x-rays may only show minimal changes. Radiological evidence of
the condition may only be clearly visible on an MRI and bone scan. In more
severe cases, sclerosis, fragmentation, collapse of the metatarsal head, and
severe arthritis, may make the condition easily visible on an x-ray.
Treatment
Conservative treatment consists of nonsteroidal
anti-inflammatory medications, activity modification, orthotics, and immobilization
with a short leg cast. Surgical intervention involving a joint debridement is
indicated only after the failure of all conservative measures. Other procedures
may be indicated depending on the complexity and severity of the case.
