Persistent Metatarsalgia Caused by Freiberg's Disease

Zusammenfassung

Bei Sportlern mit persistierender Metatarsalgie sollte an das Vorliegen eines Morbus Freiberg (Synonym: aseptische Nekrose der Mittelfußköpfchen Freiberg-Köhler II) gedacht und die entsprechende bildgebende Diagnostik veranlasst werden. Es wird eine Kasuistik mit verzögerter Diagnosestellung und operativer Behandlung geschildert. Obwohl die Ätiologie des Krankheitsbildes bisher unklar ist, ergibt eine frühzeitige Diagnose mit entsprechender Behandlung bessere Resultate als spätere Rückzugsoperationen.

Abstract

Objectives

To enhance the awareness and hence early diagnosis of Freiberg's disease in sportspersons complaining of metatarsalgia.

Methods

A case report is presented wherein the correct diagnosis was made late in the natural pathogenesis of the disorder.

Results

Salvage surgery was carried out but prevention and preservation of the anatomy would be preferred.

Conclusions

Although the exact etiology of Freiberg's disease remains uncertain, early diagnosis and appropriate treatment is desirable rather than a salvage procedure.

References

• 1 Binek R, Levinsohn E M, Bersani F, Rubinstein H. Freiberg's disease complication unrelated trauma.  Orthopedics. 1988;  11 (5) 753-757
• 2 Campbell W C. Infraction of the head of the second and third metatarsal bones: report of cases.  Am J Orthop Surg. 1917;  15 721
• 3 Cracchiolo A, Kitaska H B, Leventen E O. Silicone implant arthroplasty for second metatarsal joint disorders with and without hallux valgus deformities.  Foot and Ankle. 1988;  9 (1) 10-18
• 4 Crenshaw (ed) A H. Campbells Operative Orthopaedics. St. Louis; C. V. Mosby 1987: 959
• 5 Freiberg A H. The so-called infraction of the second metatarsal bone.  J Bone Joint Surg. 1926;  8 257
• 6 Freiberg A A, Freiberg R A. Core decompression as a novel treatment for early Freiberg's infraction of the second metatarsal head.  Orthopedics. 1995;  18 (12) 1177-1178
• 7 Gauthier G, Elbay R. Freiberg's infraction: A subchondral bone fatigue fracture, a new surgical treatment.  Clin Orthop. 1979;  142 93
• 8 Hay S M, Harris N J, Duckworth T. Freiberg's disease present in adjacent metatarsals.  The Foot. 1995;  5 95-97
• 9 Hay S M, Smith T WD. Freiberg's disease: an unusual presentation at the age of 50 years.  The Foot. 1992;  2 176-177
• 10 Hoskinson J. Freiberg's disease: A review of the long-term results.  Proc R Soc Med. 1974;  67 106-107
• 11 Jahss (ed) M H. Disorders of the Foot. Philadelphia; W. B. Saunders 1982: 207-211
• 12 Katcherian D A. Treatment of Freiberg's Disease.  Orth Clinics of North America. 1994;  25 (1) 69-80
• 13 Mann (ed) R A. Surgery of the Foot. St. Louis; Mosby 1986: 274-277
• 14 Mitchell D G. Using MR imaging to probe the pathophysiology of osteonecrosis.  Radiology. 1989;  171 (1) 25-26
• 15 Smillie I S. Freiberg's infraction (Kohler's second disease).  J Bone Joint Surg. 1957;  39 B 580-584
• 16 Stanley D, Betts R P, Rowley D I, Smith T WD. Assessment of etiologic factors in the development of Freiberg's disease.  J Foot Surgery. 1990;  29 444-447