כף רגל

רציתי לדעת מהי מחלת פריברג {כף רגל] למה היא גורמת ומה אופן הטיפול בה תודה

Freiberg's Disease -------------------------------------------------------------------------------- - Discussion: - anterior metatarsalgia that involves head of second metatarsal; - occurs during the growth spurt at puberty - most are female; - caused by avascular necrosis of the metatarsal head; - from repetitive stress with microfractures at the junction of the metaphysis AND the growth plate - these fractures deprive the epiphysis of adequate circulation; - disease is more common in pts whose 1st metatarsal is shorter than 2nd metatarsal, which increases wt on 2nd metatarsal head; - in adulthood, DJD may develop in MTP joint; - Clinical Manifestations: - pain in the forefoot, usually localized to head of the second metatarsal; - wearing of high heeled shoes makes condition worse; - localized swelling AND limitation of motion in MP joint; - Radiologic Findings: - initially the epiphysis becomes sclerotic; - early in disease, joint space is widened, much later, it narrows & irregular bony surfaces, sclerosis, & bone spurs at margins give the appearance of osteoarthritis; - epiphysis becomes fragmented followed by osteolysis & reconstitution of bony archetecture; - fragmentation AND osteolytic phases: - metatarsal head becomes irregular, widened, AND flattened at articular surface; - Diff Dx: - Ewing's Sarcoma - Stress Fracture - Osteosarcoma - Treatment: - initial management includes proper foot wear w/ metatarsal bar OR pad placed beneath the involved bone; - limit activity for four to six weeks; - w/ severe symptoms consider immobilizing foot in short leg walking cast until symptoms subside, usually in 3-4 weeks; - surgical indications: rare: - failure of conservative treatment; - surgery may be warrented to remove metatarsal heads;