Freiberg Disease

What is Frieberg disease?

This is a problem encountered most frequently in young adults. In this the blood supply to part of the metatarsal head (that part of the toe bone, where the toe connects to the foot) is disrupted. This eventually leads to arthritic (degenerative) changes in this toe joint. Friebergs disease is the name given to this condition when it affects the joint of the second toe specifically.

What causes Frieberg disease?

No definite cause can be attributed, although a weak relationship with repetitive stress (such as wearing high heels), trauma or a long metatarsal compared to the adjacent one have been attributed to this condition.

What are the symptoms caused by this condition?

Pain and stiffness of the affected toe joint is the commonest complaint. Some may have slight swelling and redness due to inflammation of the surrounding soft tissues. A bony spur may be present later in this condition. Pain will be reproduced on attempting to manipulate the toe joint.

How is this condition diagnosed?

Your consultant will examine your foot clinically and get an Xray of the foot. This usually makes the diagnosis clear. X-rays will be taken to determine whether there is any underlying arthritis, a long ray of the foot which may contribute to this condition.

Can the condition worsen?

People function normally with this problem for years without any symptoms. But if the symptoms worsen, particularly due to arthritic changes then it will be worthwhile discussing the options of treatment.

What treatment options are there?

Options are based on the degree of severity of symptoms. Most patients are seeking advice and reassurance.

Non surgical options are:

Footwear modification and splints:
A wide toe box will prevent the bone spur from rubbing against the shoe. Insoles such as a metatarsal bar or dome may be used to ease movement at the joint.

Surgery
Surgery is the last option to be employed if non surgical treatments have failed. Early on in the condition the surface of the affected joint is realigned by a bone cut ‘osteotomy’ to ease symptoms. Later on in the condition when arthritis sets in, a ‘cheilectomy’ is performed.This involves removing the bone spur which affects the joint. Both these are relatively minor surgical procedure Further information on this procedure is available under ‘surgery for Frieberg disease’ in surgical procedures.

Is surgery necessary?

The decision to proceed with surgery should be taken after non surgical options described above have been exhausted. The majority of patients will benefit from shoe wear modifications. If symptoms continue to affect lifestyle and function in spite of this then surgery may be discussed with your consultant and he will advise you regarding the pros and cons of surgery.