Avascular Necrosis: causes, symptoms and treatment options

Updated 11/18/2019

What's Avascular Necrosis (Freiberg’s Disease)

 

Avascular Necrosis (AVN), also called Freiberg’s Disease, Osteonecrosis or Bone Infarction, is death of bone tissue due to interruption of the blood supply.

 

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.

 

This injury causes the rounded end of the bone to flatten out, and leads to a reduction or loss of blood flow to the toe. It is critically important to get this properly diagnosed properly and treated quickly and properly in children.

What Causes 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.

 

Additionally, risk factors such as chemotherapy, high dose of steroid use, sickle cell disease are associated with avascular necrosis.

 

 

Symptoms of Avascular Necrosis

Because the injury develops over a long period of time, it may be tough to detect avascular necrosis in its early stages. 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 and loss of range of motion in the affected toe
  • Symptoms in one or both feet
  • Joint pain and 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

 

 

Diagnosing AVN

Avasuclar necrosis may look normal on an X-ray in its early stages, so your doctor may order a magnetic resonance imaging (MRI) scan, computerized tomography (CT scan) or bone scan.

  

 

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.

 

Conservative treatment options

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 nonsurgical treatments 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 physical therapy, rigid soled shoes and custom fitted orthotics with the metatarsal head cut out. Anti-inflammatory medications can reduce pain and inflammation.

 

Surgical Options

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. These include:

 

Joint clean-up

This procedure involves the removal of loose bones and spurs in the joint.

 

Cartilage and/or joint 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.

 

 

Why UFAI is the Right Choice for Pediatric Foot and Ankle Conditions

 

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.

  • Foot and Ankle Surgeon and Director of University Foot and Ankle Institute
    Dr Bob Baravarian, University Foot and Ankle Institute

    Dr. Bob Baravarian is a Board Certified Podiatric Foot and Ankle Specialist. He is currently a member of UCLA Medical Group, Chief of Podiatric Surgery at Santa Monica/UCLA medical center and Orthopedic Hospital and an assistant clinical professor at the UCLA School of Medicine. He also serves as Director of University Foot and Ankle Institute.

     

    Dr. Baravarian has been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy and trauma/reconstructive surgery of the foot and ankle. He is also fluent in five languages (English, French, Spanish, Farsi and Hebrew),

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