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.