Avascular Necrosis of the Metatarsal Head

Aka: Avascular Necrosis of the Metatarsal Head, Freiberg's Disease

1. See Also
   1. Osteochondrosis
2. Epidemiology
   1. Affects teens
   2. Girls predominate by a factor of 3-4
   3. Most associated with ballet and dance
3. Pathophysiology
   1. Unknown etiology
   2. Disordered ossification of the Metatarsal head (most often the second Metatarsal)
      1. Avascular necrosis (or aseptic necrosis) of the Metatarsal head
4. Risk Factors
   1. Trauma
   2. Repetitive stress
   3. Improper shoes
   4. Decreased blood supply to the affected area
5. Symptoms
   1. Pain and swelling at the affected metarsal head
   2. Typically unilateral (90% of cases)
   3. Worse with weight bearing
6. Signs
   1. Metatarsal-phalangeal joint (MTP) inflammation
      1. Tenderness and swelling over the involved Metatarsal head
      2. Restricted Range of motion
   2. Metatarsal head palpably enlarged
7. Imaging: Foot XRay
   1. Sclerosis and flattening of the involved articular surface of the Metatarsal head
   2. Widening and irregularity of Metatarsal head
   3. Flattening and collapse of MTP joint with cystic changes
   4. Loose bodies sometimes present
8. Management
   1. NSAIDs
   2. Warm soaks
   3. Local Corticosteroid Injection
   4. Well padded shoes
   5. Anterior Metatarsal bar or pad
      1. Shifts pressure from Metatarsal head
   6. Arthroplasty for persistent pain
9. References
   1. Atanda (2011) Am Fam Physician 83(3): 285-91
   2. Carmont (2009) Foot Ankle Int 30(2): 167-76