Capsulitis of the Second Toe
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Freiberg Disease is a rare condition that most commonly affects the second metatarsal head, but in some cases, it can affect the 2-5th metatarsals. Freiberg Disease results from a change in the structure of the metatarsal head where instead of having a rounded head, it begins to flatten with sharper edges. As a result, the change of position can cause pain, inflammation and swell in the forefoot.
Freiberg’s Disease is more common in women than men, and we believe it develops during childhood and teenage years but may not become symptomatic until later in life.
Freiberg Disease can cause pain on the forefoot when standing or walking. There may be slight swelling on the forefoot, while symptoms often worsen when wearing high heels or carrying out impact activities such as jumping or running.
The patient may demonstrate a visible limp, especially in the younger patient, and there may be stiffness of the surrounding metatarsal heads.
The exact cause of Freiberg Disease remains uncertain. Still, it is believed to be the result of repetitive strain on the metatarsal growth plate that results in reduced blood supply to the metatarsal head and, in turn, avascular necrosis.
A Physical Therapist can carry out a clinical assessment to identify the location of pain and the patient’s symptoms; the clinician will likely refer the patient for an x-ray.
An x-ray usually is sufficient to confirm the diagnosis. Still, in some instances, an MRI may be required to rule out any other soft tissue injuries in the forefoot that may be contributing to the pain.
Treatment for Freiberg Disease varies depending on the severity of the symptoms. In mild cases, Physical Therapy is appropriate, which involves insoles to offload the affected metatarsal and provide additional cushioning. A discussion around appropriately sized footwear that are stable and cushioned is beneficial.
Strengthening and mobility exercises are beneficial to optimise the mechanics of the foot and ankle, reducing the force being placed through the forefoot alongside anti-inflammatories.
If conservative treatment is unsuccessful, then operative treatment is appropriate. There are numerous types of surgical options, such as arthroscopy or debridement, but these decisions should be discussed with your Foot and Ankle Orthopaedic consultant.
How long does Freiberg’s Disease take to heal?
Freiberg's disease takes approximately 4-6 weeks to heal after wearing a walker boot.
Can you get Freiberg’s Disease in both feet?
In most cases, Freiberg Disease occurs in one foot only, but it is possible to get Freiberg’s Disease in both.
Can I run with Freiberg’s disease?
You can continue to run with mild symptoms of Freiberg’s disease. For more severe symptoms of Freiberg’s disease, we recommended having treatment under the care of a medical professional. Most cases return to running after successful treatment.