Avascular Necrosis: Freiberg’s Disease

Updated 8/21/2018

Avascular necrosis is characterized by a fracture and collapse of the metatarsal head. This causes the rounded end of the bone to flatten out, and leads to a reduction or loss of blood flow to the toe.

 

It usually occurs in the second metatarsal (the toe next to the big toe), but it can occur in the third or even fourth toes as well.

 

Our dedicated team of experts pride themselves in offering the most advanced, comprehensive and compassionate care to our pediatric patients. They are committed to get your child back into action and doing what they love, with the least invasive treatment possible.

Causes of Avascular Necrosis

Avascular necrosis, also known as Freiberg’s disease or Freiberg’s Infarction or Infraction, is a painful condition that frequently affects young athletes, especially teenaged girls.

 

The causes of a particular case of avascular necrosis are difficult to pin down, but the condition is often caused by overuse and repetitive stress to the area, or what specialists refer to as “chronic microtrauma.” Runners, soccer players, and dancers tend to be especially vulnerable to Freiberg’s disease.

 

Symptoms of Avascular Necrosis

Because the injury develops over a long period of time, it may be tough to detect avascular necrosis early on. If your child is complaining of these symptoms, you may want to have him or her evaluated by a foot and ankle specialist:

  • Dull aching in the front of the foot
  • Redness and swelling at the metatarsal head
  • Pain when the toes are repeatedly bent
  • Stiffness in the affected toe
  • Symptoms in one or both feet
  • Tenderness in the metatarsal head (at the base of the toe)
  • Limping
  • Symptoms that start out as mild, but worsen over time
  • Symptoms progress to chronic debilitation

  

Treating Youth Avascular Necrosis

Avascular necrosis is easiest to treat when it is caught early. However, due to the progressive nature of the condition, many patients fail to come in for evaluation until symptoms have already become debilitating.

 

In adults, severe cases of avascular necrosis may require surgery, but treatment is trickier for children and teens because their feet haven’t stopped growing yet. The common surgical techniques used on adults – osteotomy or bone/cartilage transplant – might damage a young patient’s growth plate and stunt growth in the bone.

 

For this reason, UFAI specialists recommend a non-invasive course of treatment to limit motion in the joint and relieve symptoms until the growth plate closes, at which time surgery may be recommended. In the meantime, your child’s doctor may recommend rigid soled shoes and custom fitted orthotics with the metatarsal head cut out.

 

Avascular Necrosis Surgery

Your specialist will keep a close watch on your child’s injury and bone development while the area heals. After a few months or years, when the growth plate has closed, one or more surgical procedures may be performed; the correct procedures will be prescribed based on your child’s individual case:

  • Joint clean-up. This procedure involves the removal of loose bones and spurs in the joint.
  • Bone and/or cartilage replacement. Healthy issue from elsewhere in the foot is grafted onto the collapsed metatarsal head.
  • Implant. A surgical implant is secured onto the metatarsal bone.
  • Metatarsal head resection. A last resort technique that is not typically performed on younger patients, this procedure involves removal of the bone and replacement of a surgical filler to maintain the length of the toe.
Over 200,000 happy UFAI patients and growing
  • Yelp
    I can't express how grateful I am for The University Foot & Ankle Institute! I rolled my ankle a while back, and these guys had me fast on the road to recovery. They have experienced surgeons and therapists and 8 loca...
    Steven K.
  • ZocDoc
    Was very impressed with the professionalism of the entire office. Very courteous and knowledgeable nurses - prompt and gentle too.
    Ronald B.
  • Yelp
    Communication is easy with all levels of staff. I love the reminders that are done via computer. There are a lot loose ends in my day, and the reminders help me stay organized.
    Sharon E.
  • CustomerSure
    I have had a hard time finding a doctor that is not rushing and truly listens. Dr. Campbell is really the best doctor I have been to in Santa Barbara. He listens, is thoughtful, and wants to make sure I understand. I ...
    Pauline C.
  • Yelp
    I saw Dr. Baravarian after being misdiagnosed by a previous doctor. I was suffering from foot pain for several months - I am a runner and even short walks were becoming increasingly painful. Everyone in the office is ...
    Christie C.
  • Yelp
    I am so surprised by the negative reviews over insurance billing.  Everyone hates insurance companies and I consider myself lucky when insurance follows through and gets it right! If there is an issue with my insuranc...
    Steven L.
  • Yelp
    I love Dr Bob! I am a runner and my feet were hurting so badly that I wanted to stop doing the activity that I loved.  I went to him reluctantly on a recommendation from a friend and his friendly office staff brought ...
    A.M.
  • Google+
    I am an avid runner, but had a foot injury that made even walking excruciatingly painful. I went to University Foot and Ankle Institute after being misdiagnosed by another doctor. Everyone in the office is so nice, fr...
    Christie C.
  • ZocDoc
    Dr. B gave me excellent advisement regarding several bruised toe nails on my right foot. His assistant Alex trimmed my toe nails. I was a little scared at first, but he had very good technique and it didn't hurt at all.
    Sarah A.
  • Yelp
    I had an absolutely great experience with Dr. Morris at this office.  I had a bad ankle/foot injury and although initially they didn't have an appointment available for several days later, they heard my case and agree...
    Matthew D.
Same Day Appointments
Now Available!

Or call 877-989-9110

24 hours a day, 7 days a week