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Freiberg's Disease | Find Your Stride | Edinburgh Podiatrist

Freiberg's disease, also known as osteochondrosis of the metatarsal head, is a foot condition that affects the growth plate of the second metatarsal bone. This disorder primarily occurs during the adolescent growth period, typically between the ages of 13 and 18, and is more common in females. Named after the German surgeon, Alfred H. Freiberg, who first described the disease in 1914, it often causes significant pain and discomfort in the forefoot.

An x-ray of a right foot
X-ray of a foot AP view

The exact cause of Freiberg's disease is still unknown, but it is believed to be a result of biomechanical factors combined with trauma or repetitive stress to the foot. In some cases, it can be associated with foot structure or excessive pressure on the affected metatarsal bone. This increased pressure can disrupt the blood supply to the bone, leading to its collapse and subsequent degeneration.

Prevalence-wise, Freiberg's disease is considered relatively rare, with an estimated incidence of 0.3% of the general population. However, due to its specific age group susceptibility and potential for misdiagnosis, the actual prevalence may be higher. Females are more commonly affected, with a reported male-to-female ratio of approximately 1:5.

The most common symptom of Freiberg's disease is persistent pain and tenderness in the forefoot, especially during weight-bearing activities such as walking or running. Other associated symptoms may include swelling, stiffness, and limited range of movement. The severity of symptoms can vary among individuals, ranging from mild discomfort to severe pain that affects daily activities.

When it comes to treatment options, the approach to managing Freiberg's disease generally depends on the stage of the disease and the severity of symptoms. In the early stages, conservative treatments are often recommended. These include rest, avoiding activities that worsen symptoms, and using ice packs or anti-inflammatory medications to relieve pain and reduce inflammation. In some cases, the use of custom orthotics or shoe modifications can help alleviate pressure on the affected area and promote healing.

If conservative measures fail or the disease progresses to later stages, more invasive treatment options may be necessary. These can include immobilization with a cast or walking boot to allow the bone to heal, physical therapy to improve foot strength and flexibility, or the use of non-weight bearing supports such as crutches. In rare cases, surgical intervention may be required to remove damaged portions of the bone or realign the metatarsal to alleviate pain and restore normal foot function.

In conclusion, Freiberg's disease is a rare foot condition that primarily affects adolescents, particularly females. While the exact cause remains unclear, the condition can lead to significant pain and discomfort in the forefoot. Conservative treatments are typically the first line of management, with surgery reserved for severe cases. Early diagnosis and intervention are crucial for successful outcomes, emphasising the importance of seeking medical attention if experiencing persistent foot pain and related symptoms.

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