Freibergs disease – Interesting Facts, Symptoms, Diagnosis and Treatment

Freibergs disease

Freibergs disease is a rare medical condition.

The target areas of the body affected are the Foot long bones called as the second and third of the metatarsals

Who is at risk for Freibergs disease

Adolescence age group are more affected, especially the second decade

Any age are susceptible to this disease

How common is Freibergs disease

• Age of presentation – The Peak being 11 to 17 years, even can affect the females of seventh decade
• Gender – ratio of affected, Women to Men 5:1, the only osteochondrosis which is more common in women than men
• Percentages of the affected areas – 68% second metatarsal, 27% in third metatarsal and the fourth metatarsal in 3%
• Less than 10% reported the bilateral feet involvement
• Numerous cases of Freiberg’s disease are asymptomatic or resolve spontaneously; thus, the prevalence of the disease is not clear. However, it is regarded as a rare disease.

Symptoms of Freibergs disease

The most commonest symptoms are

• Foot Pain
• Stiffness of the foot
• Swelling of the affected foot
• Tenderness over the affected foot
• Restriction of movements of the feet

The painful, limited range of motions and the stiff foot results in abnormality of walking pattern, often a limp.

Few people tend have an abnormal sensation of feeling of hard surface while walking, like the perception of a stone

Few affected individuals reported no symptoms.

It is not clearly understood whether these individuals develop the symptoms in the later stages of the disease.

This disease is most commonly detected in the X Rays accidentally taken for other conditions

The most common site of this disorder is the second metatarsal head (68%), followed by the third metatarsal (27%), and then the fourth (3%). The fifth metatarsal head is rarely involved. The disease is usually unilateral and affects just a single metatarsal. Bilateral involvement is rare, especially in the first metatarsal head described in the literature 

What triggers the foot pain in this disease?

The usual trigger factors are

• exercise, most commonly the walking
• any physical activity which involves the weight bearing

What Causes Freibergs disease

Currently no studies support the etiology of this disease.

There are few scientists who analyse the below likely factors which might be the cause of the Freibergs disease

• Environmental Factors
• Lifestyle Factors
• Influence of multiple genes

The recent theories concentrate on the effects of the triggering factors on this condition, if principally the triggering event is a vascular related like a consistent avascular necrosis or an injury or trauma related

This disease might be a multifactorial condition as per few researchers

How is Freibergs disease diagnosed?

The diagnosis of suspected Freibergs disease is confirmed by

• X-ray
• Bone Scan
• Magnetic resonance imaging (MRI)
• Laboratory Studies

The Cardinal Symptoms and signs often confirm the presence of this disease

How is Freibergs disease treated?

The Principal aim of the treatment of Freibergs disease is to reduce the swelling and the severity of the pain

• Rest is often advised
• Activities needs to be modified with the additional supports such as shoe inserts, crutches and casts of various types

Factors which influence the treatment modalities of this disease

• Age of the affected
• The Presence of characteristic symptoms and signs
• Severity levels of the disease

The pain is usually treated with the nonsteroidal anti-inflammatory drugs (NSAIDs).

Surgery may be recommended when other treatment modalities are not efficient.

Prognosis of Freibergs disease

Surgery is needed for the patients presenting at high grades.

The aim of the surgery is to reduce the progression to arthritis and restore the articular congruency 

Good prognosis long term is achieved by the patients who respond to the conservative management. These are the ones with Smillie stage 1 through 3