Case Reports and Series| Volume 56, ISSUE 3, P683-686, May 2017

Idiopathic Avascular Necrosis of First Metatarsal Head in a Pediatric Patient


      Idiopathic avascular necrosis of the first metatarsal head rarely occurs in pediatrics. The present case of avascular necrosis of the first metatarsal head occurred in a 13-year-old male who came to the clinic with a 9-month history of pain in the first metatarsophalangeal joint. Conservative treatment had been applied for 9 months, but the pain had not been relieved. Therefore, surgical treatment, including decompression and debridement, was performed in the first metatarsal head of the patient. After 6 months of follow-up monitoring, full range of motion of the first metatarsophalangeal joint was observed, and the pain had disappeared. No any other complications had developed during 18 months of follow-up monitoring.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cerrato R.A.
        Freiberg’s disease.
        Foot Ankle Clin. 2011; 16: 647-658
        • Fu F.H.
        • Gomez W.
        Bilateral avascular necrosis of the first metatarsal head in adolescence: a case report.
        Clin Orthop. 1989; 246: 282-284
        • Smillie I.S.
        Treatment of Freiberg’s infraction.
        Proc R Soc Med. 1967; 60: 29-31
        • Gurevich M.
        • Bialik V.
        • Eidelman M.
        • Katzman A.
        Avascular necrosis of the 1st metatarsal head.
        Acta Chir Orthop Traumatol Czech. 2008; 75: 396-398
        • Drez Jr., D.
        • Young J.C.
        • Johnston R.D.
        • Parker W.D.
        Metatarsal stress fractures.
        Am J Sports Med. 1980; 8: 123-125
        • Sarrafian S.K.
        Anatomy of the Foot and Ankle: Descriptive, Anatomical, and Functional.
        ed 2. JB Lippincott, Philadelphia1993: 79-85
        • Freiberg A.H.
        Infraction of the second metatarsal bone, atypical injury.
        Surg Gynaecol Obstet. 1914; 19: 191-193
        • Thompson F.M.
        • Hamilton W.G.
        Problems of the second metatarsophalangeal joint.
        Orthopedics. 1987; 10: 83-89
        • Helal B.
        • Gibb P.
        Freiberg's disease: a suggested pattern of management.
        Foot Ankle. 1987; 8: 94-102
        • Chao K.H.
        • Lee C.H.
        • Lin L.C.
        Surgery for symptomatic Freiberg's disease: extra-articular dorsal closing wedge osteotomy in 13 patients followed for 2–4 years.
        Acta Orthop Scand. 1999; 70: 483-486
        • McMaster M.J.
        The pathogenesis of Hallux rigidus.
        J Bone Joint Surg Br. 1978; 60: 82-87
        • Duthie R.B.
        • Houghton G.R.
        Constitutional aspects of osteochondroses.
        Clin Orthop. 1981; 158: 19-27
        • Viladot A.
        Freiberg's disease and dislocation of the second metatarsophalangeal joint: etiology and treatment.
        Clin Pod Med Surg. 1990; 7: 619-631
        • Rose N.E.
        • Feiwell L.A.
        • Cracchiolo A.
        A method for measuring foot pressures using a high resolution, computerized insole sensor: the effect of heel wedges on plantar pressure distribution and center of force.
        Foot Ankle. 1992; 13: 263-270
        • Blitz N.M.
        • Yu J.H.
        Freiberg’s infraction in identical twins.
        J Foot Ankle Surg. 2005; 44: 218-221
        • Wünschel M.
        • Böhringer A.
        Osteochondritis dissecans of both knees, both elbows, and the first metatarsophalangeal joint in a female soccer player.
        Clin J Sport Med. 2012; 22: 374-376