Freiberg’s Avascular Necrosis: A Case Report

Background: Freiberg’s disease is an uncommon condition typified by bony infarction of the second metatarsal head with a vague multifactorial etiology which tends to mostly occur in women. Case Report: A 22-year-old woman presented with second metatarsal head local pain exacerbating while walking without any prominent previous trauma history; clinical and imaging workups revealed metatarsal head osteonecrosis of Freiberg’s infarction. Conclusion: It should be kept in mind that for those complaining of forefoot discomfort, especially in the region of metatarsal heads, Freiberg’s avascular necrosis (AVN) could be a potential pathology

Osteonecrosis of the Lesser Metatarsal Heads

Osteonecrosis of the lesser metatarsal heads may be detected in both children and adults. It is also defined as Freiberg’s disease. It is an uncommon syndrome whose etiology combines potential developmental anomalies, biomechanical stresses or traumatic events, subchondral fracture and vascular injury. The second metatarsal head is the most commonly involved. The disease is much more common in females and athletes. The diagnosis is based on the clinical findings and is confirmed with plain radiographs. On physical examination, the palpable swelling, the discomfort and the motion restriction are well localized at the affected metatarsophalangeal joint. The history may be one of exacerbations and remissions, with pain aggravated by activity and relieved by rest. However, in a group of patients the disorder escapes diagnosis, until the foot is radiographically examined for a totally different reason. Radiographically, the metatarsal head may have a flattened, enlarged appearance with areas of increased sclerosis, fragmentation and collapse, resulting in incongruity of the joint surface. In the long-standing disease, the affected metatarsophalangeal joint may be narrowed and prominent secondary degenerative changes may be evident. The goal of treatment is early identification and conservative treatment of the patient, to allow bone healing and prevent rapid progression to osteoarthritis. No operative treatment modalities are effective in the early stages but surgical intervention is usually required in the late stages of the disease. The purpose of this editorial is to retrospectively review the incidence of osteonecrosis of the lesser metatarsal heads in children and adults referred at our institution and to review the relevant publications.

Autologous Bone Marrow Mesenchymal Cell Transplantation in the Treatment of Freiberg's Disease: Case Report

Background: Osteonecrosis of the metatarsal head, classically known as Freiberg's disease, presents as aseptic necrosis of the epiphysis of undefined etiology, although it may be associated with trauma, prolonged corticotherapy or systemic diseases such as sickle cell disease. There are several techniques described for the treatment of osteonecrosis secondary to sickle cell disease. Methods: Case report and the surgical description of the use of autologous bone marrow mesenchymal stem cell transplantation for the treatment of osteonecrosis of the 2nd metatarsal head. Results: Nuclear magnetic resonance imaging performed after one year of follow-up showed a regression of the findings found in the preoperative evaluation. Conclusion: This is the first time that the technique of autologous bone marrow mesenchymal stem cell implantation has been employed for the treatment of osteonecrosis of the metatarsal head. The case reported shows that the technique is safe and brings good results after conservative treatment failure.

Freiberg’s Disease of Bilateral and Adjacent Metatarsals

Freiberg’s disease is a rare condition characterized by avascular necrosis of the lesser metatarsal heads. The incidence is highest in females, and the disease is usually unilateral, affecting just a single metatarsal. In this report, we describe the first male case of Freiberg’s disease involving the second and third metatarsals in both feet, with the aim of highlighting the condition as a potential cause of such forefoot pain. One year of follow-up is provided.