What's the Diagnosis? By Dr. Erica Schramm

A 22 yo F with no past medical history presents to the ED with L forefoot pain, gradually worsening over 3 weeks. Pain is worse with weight bearing. There is no history of trauma. An xray is obtained. What's the diagnosis? (scroll down for answer)


Answer:  Freiberg's Disease

  • Freiberg's disease is a rare disorder in which a portion of the metatarsal head loses structural integrity
  • Likely due to avascular necrosis
  • Most commonly affects the 2nd metatarsal head (~68 % of cases), followed by the 3rd (~27% cases), then 4th (~3% cases)
  • Occurs most often in adolescents and young adults
  • Presenting symptoms include insiduous onset of foot pain worse with weight bearing, and physical exam is significant for swelling and tenderness over the affected metatarsal head
  • Early radiographs may show widening of the joint space; eventually sclerosis is seen with flattening of the metatarsal head
  • Treatment includes pain control, splinting, and in certain advanced cases, surgery