Freiberg Disease: An Interesting Case Managed in a Rural Coal Mine Hospital with Very Limited Resources

Abstract

Chronic foot pain with a typical clinical presentation and a certain radiological feature was first described in detail by Alfred H. Freiberg in 1914. He observed the chronic foot pain in patients having a distinctive X-ray feature of the foot with flattening of the head of the second metatarsal. He thought that the collapse and the deformity were due to trauma, causing reduced blood supply to the said metatarsal head, leading to its deformed shape and clinical presentation of chronic foot pain. Various theories since then have been postulated to describe this clinical entity and its appropriate management. Here, we present a case of chronic foot pain in a middle-aged lady who is a teacher by profession. She had to stand and walk for prolong period in her school. Her activity caused her great discomfort in her foot. After proper clinical examination and radiological studies, the case was diagnosed as Freiberg disease. Various treatment options were discussed with the patient. Then, it was decided to treat the foot pain with footwear modification by inserting a transverse padding near the metatarsal head region to offload the second metatarsal head. Patient improved a lot with this treatment, and she is doing her school duties and all her daily activities easily. Freiberg disease is one of the rare causes of chronic foot pain. We should be aware of this clinical entity, and we can manage this with a very simple shoe wear modification with very limited resources, effectively.