From the Research
For adults diagnosed with Freiberg disease on X-ray, prompt referral to an orthopedic specialist is recommended within 2-4 weeks, depending on symptom severity. The most recent and highest quality study, 1, published in 2024, proposes a treatment algorithm for Freiberg disease based on current literature and expert opinion. Initial treatment is typically conservative for 3-6 months, including:
- Activity modification
- Non-weight bearing or limited weight bearing with stiff-soled shoes or orthotic devices
- NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for pain management
- Possibly a short course of immobilization with a walking boot for acute symptoms Physical therapy focusing on toe and foot strengthening exercises should be initiated once acute pain subsides. If conservative measures fail after 6 months, surgical intervention may be necessary, with options including debridement, osteotomy, joint resurfacing, or joint replacement depending on disease stage and patient factors, as discussed in 2, 3, and 4. Freiberg disease involves avascular necrosis of the metatarsal head, most commonly affecting the second metatarsal, and treatment aims to reduce mechanical stress on the affected joint while managing pain and preventing further joint deterioration. Recovery timelines vary, with conservative management potentially requiring 3-12 months for symptom improvement and surgical recovery typically taking 3-6 months to return to normal activities.
The study 5 also supports the use of osteotomy procedures, such as Gauthier's dorsal cuneiform osteotomy, which can restore the joint space and lead to long-term clinical improvement. However, the most recent study 1 provides a more comprehensive treatment algorithm, making it the preferred guide for treatment decisions.
In terms of referral and treatment timeline, it is essential to prioritize prompt referral to an orthopedic specialist to ensure timely and effective treatment. The treatment approach should be individualized based on the patient's symptoms, disease stage, and overall health status. By following the proposed treatment algorithm and considering the patient's unique needs, healthcare providers can optimize outcomes and improve quality of life for adults with Freiberg disease.