Description
A healthy, 21-year-old man presented with a 1-year history of persistent right forefoot pain. Swelling, tenderness and restricted motion of the second metatarsophalangeal (MTP) joint were evident, especially during dorsiflexion; a positive Lachman test suggested MTP joint instability. A right foot X-ray showed a flattened and sclerotic second metatarsal head as well as joint surface irregularity (figure 1). The evident metatarsal head osteochondrosis was consistent with Freiberg’s disease, which is most common in adolescent females and is typically caused by repetitive second metatarsal head stress.1 Restricted second metatarsal base motion may increase distal metatarsal head stress or compromise blood flow to the metatarsal head, both potentially leading to metatarsal head osteochondrosis.2 Clinically, most patients present with pain during weight-bearing, swelling and tenderness; thus, most need treatment.3 Two months after osteochondral autograft transplantation, this patient was asymptomatic.
Figure 1.
Anteroposterior and oblique views of the metatarsophalangeal joint show that the second metatarsal head was flattened (arrow).
Learning points.
Generally, patients with Freiberg’s disease present to the emergency department with atraumatic foot pain.
Early recognition and appropriate treatment provide sufficient functional prognosis.
Footnotes
Contributors: KI, YJ and MT contributed to patient management. RI drafted the initial manuscript. MT critically reviewed the manuscript. All authors contributed to writing the manuscript. All the authors have provided written consent for publication.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: None declared.
Patient consent for publication: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.
References
- 1. Love JN, O'Mara S. Freiberg's disease in the emergency department. J Emerg Med 2010;38:e23–5. 10.1016/j.jemermed.2007.10.028 [DOI] [PubMed] [Google Scholar]
- 2. Carmont MR, Rees RJ, Blundell CM. Current concepts review: Freiberg's disease. Foot Ankle Int 2009;30:167–76. 10.3113/FAI-2009-0167 [DOI] [PubMed] [Google Scholar]
- 3. Miyamoto W, Takao M, Uchio Y, et al. Late-stage Freiberg disease treated by osteochondral plug transplantation: a case series. Foot Ankle Int 2008;29:950–5. 10.3113/FAI.2008.0950 [DOI] [PubMed] [Google Scholar]