Freiberg's disease

NewsBot · Mar 11, 2022

A new classification for Freiberg's disease
Lee Hoggett et al
Foot (Edinb). 2021 Dec 24

Introduction: Freiberg's osteochondrosis is an uncommon cause of foot pain. Following a national survey circulated by the British Foot and Ankle Society it was found that no classification is used to guide surgical treatment. This study aimed to create a simple, reproducible CT based classification to preoperatively plan whether an osteotomy is required.

Methods: A retrospective review of 24 CT scans of new Freiberg's diseasediagnoses over a 10 year period was conducted. These images were assigned a study number and anonymised. The scans were then reviewed in their entirety by three independent specialists who determined whether an osteotomy would be of benefit. The sagittal CT slice that displayed the widest portion of proximal articular margin of the proximal phalanx was identified and divided the articular surface into 2 zones - plantar and dorsal and this formed the basis for our classification. These sagittal slices were then reviewed independently by two surgeons to determine if patients had disease in one or both zones and re-reviewed two weeks later to assess intra-observer reliability.

Results: All 24 cases involved the second metatarsal. From reviewing the sagittal CT slices, it was felt that 18 patients were suitable for osteotomy and 6 were suitable for debridement +/- arthroplasty alone. The current classification demonstrated that 18 patients had disease confined to zone 1 only and the remaining patients had disease in both zones. Inter-observer reliability assessment had 95.8% agreement (Krippendorff's Alpha 0.897). Intra-observer reliability was 100%. Correlation of those observed to have isolated zone 1 disease and suitability for osteotomy was absolute (Pearson r = 1).

Conclusion: Dividing the metatarsal head into two zones on the widest sagittal slice of the CT scan offers an easy reproducible way to preoperatively plan surgical treatment for Freiberg's osteochondrosis. Patients with isolated zone 1 disease should be suitable for an osteotomy.
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NewsBot · Aug 4, 2022

Freiberg-Köhler disease:
clinical manifestations, diagnostics, and treatment (literature review).
Gudi S.M., Luchshev M.D., Kuznetsov V.V., Skuratova L.K., Prokaev F.V., Pakhomov I.A.
Genij Ortopedii, 2022, vol. 28, no 3, pp. 431-443. https://doi.org/10.18019/1028-4427-2022-28-3-431-443

Introduction The paper deals with the main aspects of osteochondropathy of the heads of the II–V (small) metatarsal bones. The relevance
of the problem of treating patients with Freiberg-Kohler disease can be explained by high incidence and poor results of traditional methods
of its management. Objective The aim of this work was an attempt to generalize the available data and improve the understanding of
approaches to the treatment of osteochondropathy of the heads of the II–V metatarsals. Materials and methods The publications obtained
in various information systems (PubMed, eLibrary.ru, Google Scholar) were reviewed. Results Issues of history, etiology, pathogenesis,
systematization and diagnosis of this disease were highlighted. The analysis of existing methods of treatment was carried out. Their
advantages and disadvantages were assessed. Conclusion Despite more than a century of studies on Freiberg-Kohler disease, the available
literature is scarce. Most works are case reports or series of cases describing small samples. This fact significantly reduces the scientific
value. Thus, improving the methods of diagnosis and treatment of patients with this disease based on the foundations of evidence-based
medicine is a task of current traumatology and orthopedics.
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NewsBot · Nov 21, 2022

Successful treatment of advanced Freiberg’s Disease with a Modified Weil osteotomy: 5-year follow up A Pilot case series with a review of the literature.
SahilKooner et al
The Foot 17 November 2022, 101952

Highlights
•Frieberg’s infraction is the 4th most common osteochondroses
•Commonly affects the second metatarsal head
•AVN causes collapse and degenerative changes of the affected metatarsal head
•Modified Weil osteotomy is a simple and effective procedure that resects diseased head and rotates preserved plantar cartilage dorsally
•Modified Weil osteotomy can be done safely with minimal complications
•Modified Weil osteotomy has good to excellent outcomes in even advanced-stage disease
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Introduction
Treatment for Freiberg’s disease is largely conservative. For severe disease and refractory cases, there are various surgical options. The purpose of this study was to report the 5-year clinical outcomes of a modified Weil osteotomy in the treatment of advanced Freiberg's disease.

Methods
Twelve patients (12 feet), with a mean age of 30.7 years (range 17-55), were treated with synovectomy and modified Weil osteotomy of the affected distal metatarsal head. There were 10 females and 2 males. Clinical outcomes were independently evaluated pre and postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and a subjective satisfaction score. Radiological union was evaluated postoperatively. Nine (75%) feet involved the 2nd metatarsal and 3 feet (25%) involved the 3rd metatarsal. According to the Smillie classification, 6 feet were Grade IV and 6 feet were grade V.

Results
No patients were lost to follow up and the mean follow-up time was 5.2 years (4-7). AOFAS scores improved from 48.1 +/- 7.4 to 88.9 +/- 10.1 postoperatively giving a mean improvement of 40.8 (p<0.001). In total, 92% of patients were satisfied with their operation at latest follow-up, reporting excellent or good results. All patients had postoperative radiological union. One patient had a superficial postoperative infection that was successfully treated with oral antibiotics.

Conclusion
Modified Weil osteotomy is an effective treatment for advanced Freiberg's disease with good outcomes and few complications.
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NewsBot · Dec 21, 2022

FREIBERG`S DISEASE OF LESSER METATARSALS TREATED WITH BONE GRAFTING AND AUTOLOGOUS MATRIX IINDUCED CHONDROGENESIS (AMIC) MEMBRANE –A SERIES OF 10 CASES
AyshaRajeevWilliamYallopKailashDevalia
Foot and Ankle Surgery 16 December 2022

Background
Freiberg’s infraction is osteonecrosis of lesser metatarsal heads most commonly affecting adolescent females. They usually present with pain and swelling of the forefoot. MRI is useful investigation in the early diagnosis. It is a self-limiting disease and the main stay of treatment is non operative. Surgery is indicated in failed conservative management which include open debridement, cheilectomy, micro fracture, osteotomies and excision arthroplasty with varying success.

Methods
A retrospective analysis of ten patients with Freiberg`s disease of the lesser metatarsals treated with open debridement, microfracture, bone grafting and application of AMIC (Autologous Matrix induced Chondroplasty) membrane was carried out. The patients were followed up to five years and the outcome measures were scored using Manchester-Oxford Foot Questionnaire (MOxFQ) and EQVAS best health scores.

Results
The mean age was 42.7 years and follow-up time was 36.4 months. The most common site was second metatarsal, eight (80%) followed by third metatarsal, two (20%). The mean base line MOxFQ was 72.5 (95% CI- 45±100) which improved to 42.5 (95%CI- 2.5±82.5) at one year. The mean baseline VAS improved from 26.4(10.2±42.6) to 30.3 (95%CI- 2.1±58.5) at one year. The mean MOxFQ and VAS at the end of 36 months was 31.4(95%CI-6.6±57.2) and47.3(4.3±80.3) respectively.

Conclusions
Open debridement of the Freiberg`s disease combined with microfracture of the defect, bone grafting and application of AMIC membrane shows reliable functional and radiological outcomes at short term follow up.
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NewsBot · Oct 11, 2023

Evidence-Based Treatment Algorithm for Freiberg Disease
Ichiro Yoshimura et al
Cartilage. 2023 Oct 10

Freiberg disease is a type of osteonecrosis of the metatarsal head that predominantly occurs in young females and adolescents, although it may occur at any age. The pathophysiology is multifactorial and may involve trauma, altered foot biomechanics, systemic disorders, and arterial insufficiency. The most typical location is the second metatarsal head, but Freiberg disease may also occur in other lesser toes. Nonoperative treatment is best applied in the early stage of the disease; if this is ineffective, surgical treatment is recommended. Currently available surgical procedures include debridement, osteotomy, osteochondral grafting, microfracture, interposition arthroplasty, implant arthroplasty, and metatarsal shortening arthroplasty. In this article, we propose a treatment algorithm for Freiberg disease based on the current literature and expert opinion.
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NewsBot · Oct 31, 2023

CT-based Five-Segment classification in Freiberg's infarction: Evaluation of Its Intraobserver and Interobserver Reliability
Yi Ren et al
Foot and Ankle Surgery 30 October 2023

Background
According to the location and frequency of osteonecrosis zone of metatarsal head, a map of osteonecrosis zone was drawn for Freiberg’s infarction. The objective of the current study is to develop a new computed tomography-based Five-Segment classification system for Freiberg's infarction and testify if it has good intra- and interobserver reliability or not.

Methods
According to the location and its frequency of osteonecrosis zone of metatarsal head, a map of osteonecrosis zone was drawn. According to the distribution of osteonecrosis zones of metatarsal heads, we proposed the Five-Segment classification system. Four evaluators evaluated each radiography and computed tomography (CT) twice at 8-week intervals. To test the reproducibility of the Five-Segment classification system, the interobserver and intraobserver reliability of this classification system comparing with that of the Smillie classification by four observers using the kappa statistic.

Results
The 80 cases were classified into five reproducible types by using Five-Segment classification system: type Ⅰ, two (2.5%) cases; type Ⅱ, ten (12.5%) cases; type Ⅲ, 42 (52.5) cases; type Ⅳ, 24 (30.0%) cases; type Ⅴ, two (2.5%) cases. The mean kappa value for interobserver reliability using Smillie classification systems was 0.562 (95% CI: 0.531 to 0.585), whereas the mean kappa value was 0.828 (95% CI: 0.801 to 0.852), by using Five-Segment classification; the mean kappa values for intraobserver reliability by using Smillie classification and Five-Segment classification were 0.777 (95% CI: 0.762 to 0.792) and 0.860 (95% CI: 0.843 to 0.895), respectively.

Conclusions
The new Five-Segment classification system demonstrated perfect interobserver and intraobserver agreement between evaluators in the management of Freiberg’s infarction. Prospective studies should be done to evaluate its prognostic value and utility in clinical practice.
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NewsBot · Nov 2, 2023

Successful treatment of advanced Freiberg's disease with a modified Weil osteotomy, 5-year follow up: A Pilot case series with a review of the literature
Sahil Kooner et al
Foot (Edinb). 2022 Nov 17:57:101952

Introduction: Treatment for Freiberg's disease is largely conservative. For severe disease and refractory cases, there are various surgical options. The purpose of this study was to report the 5-year clinical outcomes of a modified Weil osteotomy in the treatment of advanced Freiberg's disease.

Methods: Twelve patients (12 feet), with a mean age of 30.7 years (range 17-55), were treated with synovectomy and modified Weil osteotomy of the affected distal metatarsal head. There were 10 females and 2 males. Clinical outcomes were independently evaluated pre and postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and a subjective satisfaction score. Radiological union was evaluated postoperatively. Nine (75%) feet involved the 2nd metatarsal and 3 feet (25%) involved the 3rd metatarsal. According to the Smillie classification, 6 feet were Grade IV and 6 feet were grade V.

Results: No patients were lost to follow up and the mean follow-up time was 5.2 years (4-7). AOFAS scores improved from 48.1 + /- 7.4-88.9 + /- 10.1 postoperatively giving a mean improvement of 40.8 (p < 0.001). In total, 92% of patients were satisfied with their operation at latest follow-up, reporting excellent or good results. All patients had postoperative radiological union. One patient had a superficial postoperative infection that was successfully treated with oral antibiotics.

Conclusion: Modified Weil osteotomy is an effective treatment for advanced Freiberg's disease with good outcomes and few complications.
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NewsBot · Jan 8, 2024

Freiberg’s Disease Involving First Metatarsal Bone Bilaterally in an African Male Patient: A Case Report
Hind El-Amin et al
Cureus 15(11): e49093. DOI 10.7759/cureus.49093

Freiberg's disease is a rare disorder affecting the distal metatarsal bones. With no quantitative estimate of its prevalence, the exact pathophysiology of Freiberg's disease is not clearly recognized. However, microtrauma, repetitive injury, and vascular insufficiency have been implicated the most as predisposing factors for the condition. Freiberg’s disease typically presents in adolescent females with higher body mass index (BMI), involving the second and third metatarsal bones with an eventually destructive inflammatory process comprising swelling, hotness, tenderness, and marked restriction of movement. We report a greatly unique and highly atypical presentation of Freiberg’s disease in a middle-aged African male with bilateral and symmetrical involvement of the first metatarsal bones, a pattern of involvement that is considered highly anecdotal and atypical rarity of presentation of Freiberg's disease.
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NewsBot · Jan 12, 2024

Bilateral Freiberg disease in a young female dancer: A case report
Shailendra Katwal et al
SAGE Open Med Case Rep. 2023 Dec 23

Freiberg's infarction is the disorder of cartilage degeneration. The second metatarsal head is most vulnerable to Freiberg's infarction due to its longer length and relative immobility. It is exposed to repetitive stress even during normal activity. The multifactorial etiology of Freiberg's infarction is mentioned in the literature. It commonly affects the adolescent female with a female-to-male ratio of 5:1. High prevalence in adolescent females is explained in some literature due to wearing high heels, which leads to repetitive forced dorsiflexion injuries to the metatarsal head. Our case is an adolescent female of 20 years who was participating in dancing for 5 months. On examination, there is swelling and tenderness in the bilateral foot, more on the right side. Plain radiography showed the flattening of the head of the right second metatarsal with increased joint space. Mild sclerosis of the underlying bony cortex was seen. A mild deformity with flattening of the lateral surface of the head of the left second metatarsal was also seen.
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NewsBot · Jan 18, 2024

Concomitant synovial osteochondromatosis and Freiberg disease-like deformity of the second metatarsophalangeal joint treated with Uhthoff-osteotomy: a case report
Hüseyin Bilgehan Çevik et al
Fuß & Sprunggelenk Volume 21, Issue 4, December 2023, Pages 371-375

Synovial osteochondromatosis is a rare benign, metaplastic, proliferative, and idiopathic disease of the synovium. Although often seen in larger joints, only a few cases have been reported in the foot. The case is here presented of a 33-year-old female with concomitant synovial osteochondromatosis and Freiberg disease-like deformity of the second metatarsophalangeal joint treated with Uhthoff osteotomy.
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Freiberg's disease

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Freiberg's infraction

Freiberg's infraction

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Freiberg's disease

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Freiberg's infraction

Freiberg's infraction

Advice on a Freiberg's case

Dysplasia epiphysealis hemimelica (Trevor's disease) in the foot and ankle

Nail Lacquer in the Treatment of Nail Diseases

New cancers in type 2 diabetes with diabetic foot disease

Patellofemoral Pain Syndrome Is Associated With Chronic Disease and Allergies

Share This Page

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