Idiopathic Avascular Necrosis of First Metatarsal Head in a Pediatric Patient

Avascular necrosis of the first metatarsal head in adolescence: A case report

“…Juvenile idiopathic osteonecrosis at the MTT head, also known as Freiberg's disease, has a multifactorial etiology, including trauma with circulatory impairment, steroid use, blood dyscrasias, pregnancy, Gaucher's disease, Cushing's disease, alcoholism, dysbaric disorders, irradiation, and idiopathic etiology. 3,4,6 The incidence is low and the most common affected area is the second MTT head (68%), followed by the third MTT and the fourth MTT (27% and 3%, respectively). 4,5 Whereas secondary osteonecrosis of the first MTT head is a well described complication following distal osteotomy and lateral release for hallux valgus correction, idiopathic AVN of the first MTT head is rarely described in adolescents.…”

“…4 MRI changes include T1-decresead signal intensity that is associated with decreased cancellous bone content and heterogeneous T2increased signal intensity due to hyperemia and edema. 4,6 A pathognomonic finding on MRI is the double-line sign. Regarding clinical findings associated with AVN, painful joint-space narrowing could occur even in mild cases, while the average loss of motion ranges from 17° to 28°.…”

“…2 Kwon et al presented a case of idiopathic AVN in a 13-year-old active male, who is managed with surgical debridement and decompression after failure of 9-months of conservative treatment, with full ROM and pain disappearance at the final follow-up of 6 months. 6 The authors concluded that surgical treatment at the early stage could be helpful in adolescent patients. In our case, we decide to perform a joint debridement, a subchondral drilling, and a dorsal extra-articular closingwedge osteotomy after failure of 7-months of conservative treatment, with satisfactory outcomes at the final follow up of 8 months.…”