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  • Q&A with Australian Health Practitioners

    Is there hope for Frieberg's Disease?

    Hello, I am 29, female, and on a limited income. Since I was 12, I have had Frieberg's disease. It began with the sharp stabbing pain at the bottom/sole of the 2MTP left foot, then progressed into a swollen immovable lump. Gradually it turned into a grinding/crunching and would lock up. Now, it's a constant. The result of the x-ray showed marked flattening of the metatarsal head. The pain is worse now.. There are 2 joints in the big toe that have been pushed away from where they should be, and I get random burning pains in the abductor hallucis. About 4 joints on that foot grind and crack with minimal movement. Both ankles and knees and left hip get stiff and grind. My lower spine has degenerative arthritis. I have used NSAIDS sparingly, try to eat and exercise well (pilates helps) and use orthotics. But after so many years, the constant pain is the proverbial straw. Is there any kind of surgery to help improve mobility and quality of life at such a late stage of the disease?
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    Thanks

    Stephanie Cosgrove

    Podiatrist (General)

    Sports injuriesOccupational foot injuriesFoot painAching legs and feetDiabetesChildren's foot conditionsHeel spurs / plantar fasciitisCorns /Callus / Ingrown toenailsGeneral Podiaty / Chiropody View Profile

    Hi. I am a podiatrist. Before we get too far, this is a useful info sheet for Friedberg's disease.  http://www.walkwithoutpain.com.au/freibergs-disease  Ultimately, the 2nd metatarsal head gets traumatised due to being overloaded. This comes about because the 1st metatarsal is not doing its job properly, fails to bear weight and passes that weight over to the 2nd bone. A correctly made orthotic should do the job properly. An important feature includes a depression under the length of the 1st metatarsal head to allow it to sit low and be stabilised by the peroneus longus muscle action. Contoured padding under the sore bone will further decrease the pressure load on it. There is a surgical option to cut off the 2nd metatarsal head. The problem with that is this - initially there was too much pressure on metatarsal 2 and it got sore. Now that there aren't five bones anymore, only four, the pressure on the other bones will increase. Often metatarsal 4 will soon get sore a few months later in just the same way. For this reason, surgery such as this should be avoided, especially at your age with many years of walking in front of you. I would suggest seeing a good podiatrist and getting the orthotic insert as good as it can be. All the best with the process. Stephanie</span>

  • Dr Andrew Knox

    Podiatric Surgeon, Podiatrist (General)

    Dr. Andrew Knox is one of the most-highly qualified foot specialists in Australia, holding both a Bachelor of Podiatric Medicine and a Doctorate of Clinical … View Profile

    Orthotics (and sometimes steroid injections) can be helpful for this condition, but it really does depend on the severity as to how much pain relief they provide. Frieberg's disease often causes degenerative arthritis to develop in the 2nd metatarsal head, and it is the progressive loss of cartilage from this area that results in pain (and/or stiffness) of the joint. Surgical treatment can be very rewarding for patients with Frieberg's infarction. The specific procedure which is performed will be determined by surgeon preference and grade of disease. Commonly an ostectomy/arthroplasty (e.g. clean-up) procedure of the joint is performed, sometimes a dorsal closing wedge osteotomy of the bone is performed in conjunction to 'flip-up' any remaining cartilage on the bottom surface of the joint to the top side. I have performed joint replacement procedures for this condition also using silastic implants provided by Wright Medical. Metatarsal head resection is not usually performed to treat this condition as there is a substantially higher risk of developing transfer metatarsalgia in your other joints. Kind regards

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