Freiberg’s disease or infraction refers to osteochondrosis of the metatarsal head, often the second metatarsal, which causes pain and tenderness in the forefoot that may exacerbate during ambulatory activities.
The clinical presentation of the condition may also include swelling and limited range of motion of the metatarsophalangeal joint, depending upon the progression of the disease.
The aetiology of Freiberg’s disease remains uncertain but a combination of traumatic and vascular disruptions at the epiphyseal plate is often cited as primary causes of the ischemic necrosis.
As discussed by Bob Baravarian and Rotem Ben-Ad, from the University Foot and Ankle Institute in Los Angeles, biomechanical issues that lead to an increased loading of the second metatarsal may cause repetitive stress to the metatarsal, triggering the onset of the condition.
This makes it necessary to identify and treat conditions such as hallux valgus or hallux rigidus that could serve as contributing factors in the development of the disease, if left untreated for a considerable period of time.
Altered joint biomechanics in the form of an elongated second metatarsal bone can lead to excessive weight being placed on the second metatarsal head which can cause repetitive micro-trauma, loss in blood supply to the subchondral bone and deformation of the cartilage.
Conservative methods of treating the disease in its early stages include immobilisation with limited mobility for a period of up to six weeks in order to minimise pressure on the affected metatarsal head.
This can be augmented with the use of cortisone injections or non-steroidal anti-inflammatories to provide the patient with relief from pain at the injured metatarsophalangeal joint.
After a sufficient period of rest, MASS4D® customised foot orthotics can be used to further alleviate pain by decreasing any excessive weight placed on the metatarsal head while enforcing normal alignment of the metatarsal heads and promoting an even distribution of weight across the plantar surface of the foot.
The inclusion of MASS4D® in postoperative care for Freiberg’s disease helps in protecting the individual from recurrences by addressing any underlying biomechanical discrepancies such as hyperpronation that could lead to the development of other conditions of the foot or lower extremity.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.