Freiberg's disease

(Albert H Freiberg, 18681940, American surgeon), osteochondrosis of the metatarsal head, usually the second. Trauma or vascular insufficiency have been proposed as mechanisms but the exact aetiology is unknown. The condition most commonly affects athletic adolescent girls aged 1015 years and can be unilateral or bilateral. The condition typically presents with focal pain and tenderness, the symptoms often present initially after significant activity and increase with time. Conventional radiographs may be normal initially but later show osteopenia and a subchondral fracture or irregularity of the articular surface which can progress to sclerosis, fragmentation and flattening of the metatarsal head (Fig.1) and later reconstitution. Bone scintigraphy or MR imaging may allow an earlier diagnosis than conventional radiographs (see osteochondritis).

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