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East Florida


HCA Florida Westside Hospital


Reconstructive Foot and Ankle

Document Type


Publication Date



avascular necrosis, AVN, metatarsals, Freiberg's Infraction


Medicine and Health Sciences | Musculoskeletal Diseases | Podiatry


Avascular necrosis (AVN) of the second metatarsal is a debilitating condition characterized by the loss of blood supply to the bone, leading to cellular death and potential collapse of the affected metatarsal head. This study presents a comprehensive review of contemporary literature to elucidate the spectrum of treatment options available for managing AVN of the second metatarsal.

A systematic search of reputable medical databases yielded a total of 38 pertinent studies detailing various treatment modalities for AVN of the second metatarsal. The review encompassed surgical and non-surgical approaches, evaluating their efficacy, long-term outcomes, and complications.

Non-surgical interventions, such as protected weight-bearing, orthotic devices, and immobilization, have been employed to alleviate symptoms and potentially slow disease progression in early-stage AVN cases. However, these methods are often limited by the advanced nature of the condition at the time of diagnosis.

Surgical interventions offer a spectrum of options tailored to disease severity and patient factors. Core decompression, vascularized bone grafting, and metatarsal head resection have been considered in cases where conservative measures prove ineffective. Advanced techniques like osteochondral autograft transplantation and regenerative therapies hold promise for restoring articular surfaces and mitigating longterm joint dysfunction.

The choice of treatment modality is contingent upon factors including disease stage, patient age, activity level, and joint integrity. Emerging trends emphasize individualized treatment plans that consider the potential for joint preservation and pain relief.

Complications, such as joint stiffness, malalignment, and persistent pain, highlight the importance of careful patient selection and meticulous surgical technique in achieving optimal outcomes.

In conclusion, the management of AVN of the second metatarsal necessitates a thorough understanding of the available treatment options. While non-surgical interventions may be suitable for early cases, surgical interventions offer tailored solutions for advanced disease stages. Patient-specific characteristics should guide treatment decisions, with an emphasis on achieving pain relief, preserving joint function, and mitigating long-term complications. Prospective comparative studies evaluating the long-term outcomes of diverse treatment strategies are imperative to establish evidence-based guidelines for addressing AVN of the second metatarsal effectively.

Current Treatment Options for AVN (Freiberg's Infraction) of the Second Metatarsophalangeal Joint



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