Korean J Sports Med.  2023 Mar;41(1):45-49. 10.5763/kjsm.2023.41.1.45.

Conservative Management of Freiberg Disease with Shoe Modification and Insole: A Case Report with 2-Year Follow-up

• Suh JWo
• Park CH
• Yoon KJ
• Lee YT

• KMID: 2539689
• DOI: http://doi.org/10.5763/kjsm.2023.41.1.45

Abstract

Freiberg disease, known as a Freiberg infraction, is an uncommon disorder of the second metatarsal head of the foot. Conservative treatment is recommended as initial management to relieve symptoms and minimize epiphyseal deformity. However, due to the rarity of this disorder, there have been few reports of long-term clinical and radiologic follow-ups of Freiberg disease treated with conservative treatment. We report Freiberg disease treated with conservative management including modification of shoe and insole. A 24-year-old woman presented with right forefoot pain. In plain radiography, the sunken appearance of the metatarsal head and periarticular spurring was observed. The articular cartilage was intact in magnetic resonance imaging (MRI), corresponding to Smillie’s stage 3 and Thompson’s type 2. We prescribed carbon fiber insert, customed semirigid insole with metatarsal dome and rocker-bottom shoe to relieve pressure under the metatarsal heads. Freiberg disease maintained a well-tolerable condition during 2-year follow-up period without further progression in MRI.

Keyword

Freiberg disease; Foot orthoses

Figure

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  Fig. 1 Anteroposterior radiographs of right foot at initial (A), 1-month follow-up (B), and 2-year follow-up (C). Subtle joint space widening with flattening and sclerotic change in the second metatarsal head (arrow) was shown in 1-month follow-up (B). Sclerosis and collapse of the second metatarsal head (arrow) with sunken appearance and periarticular spurring were observed in 2-year follow-up (C).

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  Fig. 2 Proton density-weighted image and fat-suppressed T2-weighted image at initial (A, B), 16-month follow-up (C, D), and 2-year follow-up (E, F). (A, B) Initial magnetic resonance imaging (MRI) shows an ill-defined low signal lesion in the right second metatarsal head and bone marrow edema, suggesting osteonecrosis. Sixteen-month follow-up MRI (C, D) shows a slightly decreased extent of the low signal lesion with decreased bone marrow edema, which is maintained until 2-year follow-up (E, F) (White arrow; second metatarsal head).

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  Fig. 3 Shoe-wear modifications applied to the patient. (A) Carbon fiber insert, (B) customed semirigid insole with metatarsal dome, and (C) rocker-bottom shoe.

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