Which condition involves avascular necrosis of the second metatarsal epiphysis, leading to pain at the metatarsal head?

Which condition involves avascular necrosis of the second metatarsal epiphysis, leading to pain at the metatarsal head?

• A. Freiberg disease
• B. Morton neuroma
• C. Sesamoiditis
• D. Anterior tarsal syndrome

Answer: (A)

Freiberg disease is characterized by avascular necrosis of the epiphysis of the second metatarsal head, which leads to pain at the metatarsal head, especially with weight bearing. This explains why the second metatarsal head becomes the painful focus in these patients—the blood supply to the growing end of that bone is disrupted, causing collapse and pain during forefoot loading. Morton neuroma causes sharp, burning pain between toes from interdigital nerve entrapment, not specifically at the metatarsal head. Sesamoiditis affects the plantar aspect of the first metatarsophalangeal joint under the big toe, not the second metatarsal head. Anterior tarsal syndrome involves dorsum foot pain or numbness from deep peroneal nerve irritation, not focal metatarsal-head pain.

Freiberg disease is characterized by avascular necrosis of the epiphysis of the second metatarsal head, which leads to pain at the metatarsal head, especially with weight bearing. This explains why the second metatarsal head becomes the painful focus in these patients—the blood supply to the growing end of that bone is disrupted, causing collapse and pain during forefoot loading.

Morton neuroma causes sharp, burning pain between toes from interdigital nerve entrapment, not specifically at the metatarsal head. Sesamoiditis affects the plantar aspect of the first metatarsophalangeal joint under the big toe, not the second metatarsal head. Anterior tarsal syndrome involves dorsum foot pain or numbness from deep peroneal nerve irritation, not focal metatarsal-head pain.