Freiberg's disease is a destructive condition that involves the joint at the base of the 2nd toe. This condition is part of a family of bone and joint diseases known as osteochondritis. This condition essentially involves a loss of proper blood flow to the head of the 2nd metatarsal, the long bone found between the middle of the foot and the base of the 2nd toe. Although the other toe bases can be similarly effected, the 2nd toe is the most common one involved, and Freiberg's disease usually specifically refers to this toe only. The loss of blood flow can be a result of injury, such as a fracture, as well as a surgical complication or a complication if the metatarsal is prominent on the bottom of the foot. This condition is seen in women three times more frequently than men, and usually appears after the age of 13.
The symptoms will usually start with an aching, dull pain with swelling at the base of the 2nd toe during activity. Eventually, as the bone becomes destroyed, the joint will experience less motion and abnormally shaped bone can be felt on top of the joint. Pulling the toe out will cause pain, and changes on x-rays will demonstrate flattening of the joint surface with eventual destruction of the bone surface itself. An MRI will help confirm the diagnosis, especially in the disease's earlier stage.
Treatment in the early stage of this disease involves immobilizing the foot to prevent further destruction of the bone that occurs by bearing weight on the ground. A fiberglass cast and crutch use for four to six weeks, followed by a stiff-soled shoe and prescription orthotics shoe inserts. The use of high-heeled shoes should be avoided. Later stages of this disease with greater joint destruction require surgical intervention. Numerous different surgeries can be used to repair the damage, and may include simple removal of loose joint tissue, bone shortening procedures, as well as artificial joint implants or outright removal of the diseased section of bone if the joint damage is severe enough.