Freiberg’s disease (Infraction)

Freiberg’s disease can become a debilitating condition. If not treated properly, arthritic changes can occur at a young age.

Freiberg’s disease is osteochondrosis (Avascular necrosis) of the metatarsal head that most often occurs in the second metatarsal head although it can happen to any metatarsal heads. It commonly presents in adolescence, with a 5:1 female:male ratio.

Causes

Although not fully understood, the most likely caused by a combination of trauma and vascular insufficiency.

Symptoms

  • Pain
  • Swelling
  • Stiffness in the joint

Diagnosis

  • X-Ray
  • Nuclear Imaging
  • MRI

Conservative Treatment

Initial treatment is usually directed toward protection and the alleviation of discomfort.

  • Immobilisation with limitation of activity for 4-6 weeks
  • Anti-inflammatories
  • Bone Stimulator

Surgical Treatment 

As the disease process progresses or if patients seek treatment after the acute phase has passed or the disease process has progressed to joint deterioration, surgical intervention may be of benefit. Depending on the severity of the condition, the foot surgeon will recommend different procedures;

  • Cheilectomy with a cleanup of the joint and removal of any osteophytes
  • Removal of damaged cartilage
  • Decompression of the joint by metatarsal shortening osteotomy
  • Interpositional arthroplasty

How long does the operation take?

  • The operation usually takes approximately 30-40 minutes.

Is this a day procedure?

  • Yes, you can usually go home the same day.

Will I have a plaster cast?

  • No, but you will be given a postoperative shoe to wear for 4 weeks.

How long will I need off work?

This will depend on the job you do and the speed of your recovery.

  • Sedentary jobs: 2 weeks
  • Standing/walking jobs: 4 weeks
  • Manual/labour jobs: 6-8 weeks

What will happen afterwards?

  • Your first appointment is usually scheduled between 5-7 days
  • Stitches removed between 10-14 days
  • For the first 2 weeks, you should avoid walking if possible and only put your weight through your heel
  • When not walking, rest with your foot elevated to reduce swelling
  • You should be able to walk comfortably within 2 months but some swelling may last up to 12 months
  • You may start high impact exercises after 3 months

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner