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Freiberg’s disease was first described around a hundred years ago. It is not easy to determine the number of  people that are affected by Freiberg’s disease since a lot of the cases resolve on their own and may never be detected.

The condition is much more common in young women than any other demographic.

Why Does Freiberg’s Disease Occur?

The exact reason behind the occurrence of Freiberg’s disease is unknown, however repeated microfractures at the junction of the metaphysis and the growth plate are believed to be the most likely cause.

These microfractures prevent adequate blood circulation to the metatarsal bones, causing necrosis in the area. The metatarsals are bones found in the foot just behind the toes. Other reasons such as a genetic predisposition, an altered biomechanical formation of the structures in the area, and poor blood circulation are all possible causes which are being explored by researchers.

The likelihood is that more than one of these above-mentioned factors will be responsible for the occurrence of Freiberg’s disease.

Management

The treatment and overall management of the disease are aimed towards the limitations of pain and discomfort in the affected foot.

  • Rest and supportive footwear that helps reduce the pressure from the affected bone are helpful in relieving the symptoms.
  • Some people may be required to wear a foot cast and be on bed rest if the pain is particularly severe. The duration of this cast is usually around 4-6 weeks.
  • Anti-inflammatory and pain medication is useful, however, care should be taken that patients do not perform any strenuous physical activity during this period as it will prevent healing on the long run.

The doctors will make every effort to treat Freiberg’s disease in a conservative manner, however, if the condition continues to progress and worsen then other more invasive methods may need to be explored.

There are a number of surgical options that are used to treat the condition. The exact kind of surgery which is performed is chosen on the basis of clinical symptoms, surgeon preference and rehabilitation period available.

Frieberg himself advocated a simple debridement of the bone and removal of any diseased fragments of the bone. The use of a bone graft to try and repair any structural damage to the bone is also a frequently used option. The idea here is to try and restore normal support to the surrounding muscles as well as regenerate any lost tissues to rid the patient of pain and discomfort.

 Several other options exist that are more invasive, including total joint arthroplasty, excision of the metatarsal head, core decompression, and shortening of the metatarsal head are used successfully in different conditions.

It should be understood though that no consensus exists in the medical community as to what the number one most successful procedure is. Different doctors have different viewpoints with some even going so far as to say that surgery should only be used in the most extreme of cases, with all others being managed by non-surgical, conservative methods.  

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