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Hello fellow podiatrist
I,ve recently had a female 25yr old underweight patient who presented with painful unilateral 2nd toe which began 4 months ago and now the pain is extending into the ball of her foot and her arch. She has psoriasis. An X-ray showed flattening of the 2nd met head with widening of the joint space. Ive considered Freibergs, but am aware this is a juvenile condition and would appriciate some feedback.

No, Freibergs is common in juveniles, but can occur at any age. In the past 3 weeks I have picked up 2 Freibergs , both females in their 40s. Also consider psoriatic Arthropathy, but it sounds like Freibergs.

Put her into a POP immoblisation cast to reduce further joint degeneration

Also consider differential Dx including psoriatic arthritis/arthrosis, capsulitis, stress # (the Xray may not pick this up until resolution begins to occur) neuroma and functional problems. Much depends on the Hx and physical.

All the best

Bill Liggins

What then peter? Is it best to use a strategy that will reduce dorsiflexion moments about the 2nd mpj e.g. Orthoses, a rocker shoe, perhaps a met bar along the 2nd shaft. I have had quite good sucess with this strategy. Might surgery be a consideration?

Cheers Dave

Plantar plate rupture?

Can you post the xrays?

Iona

Dave,
A rocker sole modification, or if the pt has a pair of walking shoes with a stiff midsole and forefoot rocker, that often suffices.

I also get some shoes stiffened with a carbon-fibre plate added into the midsole if the shoe permits it eg Classic style trainer.