Presentation
Painful swelling of the right 2nd toe after minor trauma. Clinical suspicion of osteomyelitis. The patient is a known case of poorly controlled DM and end-stage renal disease.
Patient Data
Intra-articular fracture of the distal end of the middle phalanx of the 2nd toe with associated mild soft tissue swelling of the 2nd toe.
Mild flattening and sclerosis of the 2nd metatarsal head, a few small cystic areas in the 2nd metatarsal head, and mild widening of the 2nd metatarsophalangeal joint. Findings are impressive of Freiberg disease (avascular necrosis of the 2nd metatarsal head).
Case Discussion
Its etiology is controversial; however, most commonly thought to be related to trauma in contrast to the other causes of AVN, steroids or alcohol are usually not considered in its etiology.
2nd and 3rd metatarsals are the least mobile, probably making them more vulnerable to repeated micro-trauma. Young adolescent females are affected 3-5 times more frequently than males (unlike the other osteochondroses, which have a male predominance). It is an important review area, especially in patients with forefoot pain.
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