A Runner with a History of Foot Pain

 

Diagnosis

The patient was diagnosed with Freiberg’s disease/avascular necrosis/osteochondritis of the second metatarsal head.

 

Learnings

• This diagnosis occurs most often in patients from adolescence into the second decade of life
• The triggering event is trauma or repetitive trauma leading to metaphyseal microfractures, compromised vascular supply, and avascular necrosis
• Typically, head regions of the second or third metatarsal bones are involved

 

Pearls for Urgent Care Management and Consideration for Transfer

• The radiographic findings are those of avascular necrosis. Findings include flattened, collapsed head region of the metatarsal bone, fragmentation of the metatarsal head, loose bodies in the MP joint, zone of demarcation, sclerosis, and deformed sclerotic head upon healing
• Diagnosis is based on plain radiograph or MRI showing an avascular necrosis
• Treatment consists of rest, modification of physical activities, immobilization, and surgery if necessary

 

Acknowledgment: Images courtesy of Teleradiology Specialists.