Freiberg's Disease

What is wrong with my foot?

This is an uncommon disease where the blood supply is compromised to the metatarsal head, most commonly seen in teenage girls.

Why has this happened?

It occurs during the growth spurt at puberty, most commonly it is found in young females with a male:female ratio of 1:5. It is also more common in patients whose first metatarsal is shorter than the second metatarsal, which increases the weight on the second metatarsal head. The initial injury, as described by Freiberg, was thought to be repetitive stress with microfractures at the growth plate. The microfractures deprive the growth plate of adequate circulation, and there is avascular necrosis of the metatarsal head. Avascular necrosis can also occur later in life if the bone is traumatised.

Although the second metatarsal is most often affected, the third metatarsal may also be involved; involvement of the fourth or fifth is rare.

Symptoms include:

·       Pain in the forefoot, usually localised to the head of the second metatarsal.

·       Usually this is associated with physical activity.

·       Wearing high-heeled shoes makes it worse.

·       There may also be localised swelling and stiffness in the metatarsophalangeal joint.

·       A limp may be visible.

Do I have to have an operation?

Pads, splints, foot orthoses and special shoes can be used to provide comfort but will not cure the bone injury. Supportive footwear with a metatarsal bar or pad placed beneath the involved bone can help. Reduce weight-bearing activities for four to six weeks. If symptoms are severe, a fracture boot until the symptoms subside - usually within 3-4 weeks is considered. Pain medication may also be used and cortisone injections. If the joint is still uncomfortable despite these measures then an operation will usually be recommended.

Surgical options include:

·       Debridement

·       Bone grafting

·       Osteotomy (Controlled fracture of the bone)

·       Arthroplasty

·       Osteochondral transplantation

How successful is the operation?

90-95% of people are very satisfied with the results of the operation, as they no longer have pain from the joint. They are then able to wear normal shoes again.

Are there any risks associated with the operation?

As with all operations there are risks associated with the anaesthetic. Occasionally some patients may have complications such as infection or prolonged swelling.  There may be some residual pain in the forefoot. Occasionally the joint may not heal properly necessitating a further operation.

What will happen after the operation?

The operation is usually day case. Mr Yates will discuss this with you. You will be given a special shoe to wear over your bandages and you must wear these whenever you want to walk. The shoes must be worn for 4 weeks. You do not need to use crutches. It takes the foot a good 6 months to fully settle down after surgery.

What happens when I leave hospital?

For the first 48 hours you will rest in bed with your legs elevated and should take the painkillers prescribed for you. You will be asked to do some foot exercises during this time. The bandages will be left on for 2-4 weeks. You will be given an Outpatients appointment to return to have the bandages removed, usually at 2 weeks. You will be able to return to work from 1-6 weeks after the operation, depending on how much you need to stand or walk around for your job or whether you can work from home.