Osteochondrosis: Freiburg’s disease / Avascular Necrosis
Osteochondrosis (os-te-o-con-dro-sis) is a condition that affects bones that are still growing, the term avascular necrosis is used in an adult or if the bones have stopped growing. In the forefoot the second metatarsal is most commonly affected as this is the longest of the lesser metatarsals but is not exclusive to this bone. Both conditions involve an interruption to the blood supply to the bone which is often due to injury of a repetitive nature.
The term Freiburg’s disease is used when the condition affects the second metatarsal and most commonly occurs in females around the age of twelve. This condition produces pain during and especially after activity and may be associated with swelling and redness of the joint.
Management of this condition should be rapid as further trauma produces long term damage and arthritic changes of the joint. Within the first weeks of the condition developing x-rays often show nothing abnormal and MRI is the best investigation as this can diagnose the condition within the first few days of onset.
The condition is managed through immobilisation and activity modification. Over time and if allowed to rest the blood supply returns and if there has been alteration of the shape of the metatarsal a full recovery should be made. However, if the metatarsal has flattened and there is damage to the cartilage, over time, there is an increased chance of arthritic changes developing.