Osteochondroses of the foot represent a unique and less frequently discussed topic. This narrative review aims to provide a comprehensive overview of foot osteochondroses, highlighting their definition, pathophysiology, clinical features, diagnosis, and treatment. Historical sources, including early case reports, were included along with the current literature to picture the current knowledge on the subject. Anatomical mapping of pain locations and associated ossification centers was employed as a framework to present the various forms of foot osteochondroses. Multiple types of foot osteochondrosis were identified. The calcaneus, navicular and lesser metatarsal are among the more common involved bones. Most forms share a multifactorial etiology involving mechanical stress, vascular insufficiency, and delayed ossification. The pain is localized and common to all forms. Diagnosis relies on clinical assessment supported by radiographic and sometimes magnetic resonance imaging findings. During the acute phase, joint rest is essential. Despite the potential for spontaneous resolution, some cases can lead to structural deformities or persistent symptoms. Foot osteochondroses, although rare, require careful clinical evaluation due to their impact on pediatric patients. Increased awareness and standardized treatment approaches may improve early recognition and management, potentially reducing long-term sequelae.

Freiberg disease, characterized by osteochondrosis affecting the metatarsal head, typically afflicts adolescent athletes. However, subchondral insufficiency fractures of the metatarsal head, presenting similarly to Freiberg disease, occur in middle-aged and elderly individuals and pose unique challenges in diagnosis and treatment. This study reports three cases of osteochondral autograft transplantation (OAT) for collapsed metatarsal heads resembling Freiberg disease in middle-aged and elderly women with successful outcomes. Case 1 involved a 59-year-old woman with severe metatarsophalangeal joint (MTPJ) pain and restricted range of motion (ROM) in the second toe. Case 2 featured a 66-year-old woman with trauma-induced deformity and cystic changes in the second metatarsal head. Case 3 included a 71-year-old woman with a crushed third metatarsal head and osteophyte formation. Hallux valgus was observed in one patient; the other two had a history of minor trauma. Radiological assessments revealed deformity, with MRI indicating bone marrow edema in the metatarsal head. Histological findings showed no necrosis, differentiating these cases from classical Freiberg disease. Based on these findings, OAT was chosen to restore joint function and minimize complications such as metatarsal shortening. In all cases, metatarsal head reconstruction was performed using an osteochondral column harvested from the femoral condyle. All patients experienced significant pain relief, improved ROM, and favorable imaging findings. No pain recurrence was noted during the three to seven years' follow-up period after surgery. While classical Freiberg disease involves aseptic necrosis often attributed to repetitive stress, insufficiency fractures may arise from shear stress or subtle injury. Our cases demonstrated the effectiveness of OAT in managing advanced subchondral insufficiency fractures, even in elderly patients, by minimizing risks such as metatarsal shortening and compromised joint mobility.

Freiberg disease (FD) is a condition characterized by osteochondrosis affecting the metatarsal heads, with the second metatarsal head being the most commonly affected. Dorsiflexion Closing Wedge Osteotomy of the Metatarsal Head (DCWMO) has been conventionally employed, whereas Osteochondral Autologous Transplantation (OAT) represents a more recent technique with restricted comparative research. This study aimed to compare the outcomes of DCWMO and OAT for treating Freiberg disease (FD). Groups were established among two institutions. Institution-1 has made the treatment with OAT (8 patients) and Institution-2 has made the treatment with DCWMO (8 patients). The primary outcomes collected, including complications, range of motion, length of the metatarsal, American-Orthopaedic-Foot-and-Ankle-Society-lesser MTP-interphalangeal (AOFAS-LMI) score, visual-analog-scale (VAS), Foot-and-Ankle-Disability (FADI) score, and Short-Form-12 (SF-12), were all compared. The Sport-FADI and activity-FADI scores at final follow-up were significantly greater in the OAT group than in the DCWMO group (94.04 vs 84.75 and 97 vs 92, P = 0.021 and P = 0.04, respectively), whereas plantarflexion at final follow-up was significantly lower in the DCWMO group than in the OAT group (43.13 vs 6.88 degrees, P < 0.001). The AOFAS-LMI score at final follow-up was significantly greater in the DCWMO group than in the OAT group (86.75 vs 75.38, P = 0.013). In conclusion, this study highlights the effectiveness of both OAT and DCWMO in treating Freiberg's disease, as evidenced by significant postoperative improvements in various functional scores, including AOFAS-LMI, VAS and FADI. Notably, OAT demonstrated favorable outcomes in SFADI and AFADI and plantarflexion ROM, while DCWMO led to improved the AOFAS-LMI score.

Freiberg's osteochondrosis is an uncommon cause of foot pain. Following a national survey circulated by the British Foot and Ankle Society it was found that no classification is used to guide surgical treatment. This study aimed to create a simple, reproducible CT based classification to preoperatively plan whether an osteotomy is required. A retrospective review of 24 CT scans of new Freiberg's diseasediagnoses over a 10 year period was conducted. These images were assigned a study number and anonymised. The scans were then reviewed in their entirety by three independent specialists who determined whether an osteotomy would be of benefit. The sagittal CT slice that displayed the widest portion of proximal articular margin of the proximal phalanx was identified and divided the articular surface into 2 zones - plantar and dorsal and this formed the basis for our classification. These sagittal slices were then reviewed independently by two surgeons to determine if patients had disease in one or both zones and re-reviewed two weeks later to assess intra-observer reliability. All 24 cases involved the second metatarsal. From reviewing the sagittal CT slices, it was felt that 18 patients were suitable for osteotomy and 6 were suitable for debridement +/- arthroplasty alone. The current classification demonstrated that 18 patients had disease confined to zone 1 only and the remaining patients had disease in both zones. Inter-observer reliability assessment had 95.8% agreement (Krippendorff's Alpha 0.897). Intra-observer reliability was 100%. Correlation of those observed to have isolated zone 1 disease and suitability for osteotomy was absolute (Pearson r = 1). Dividing the metatarsal head into two zones on the widest sagittal slice of the CT scan offers an easy reproducible way to preoperatively plan surgical treatment for Freiberg's osteochondrosis. Patients with isolated zone 1 disease should be suitable for an osteotomy.

The prevalence of osteochondral changes in the metatarsal growth plates of fattening bulls was investigated. Plantarodorsal radiographic views of the metatarsal region of 204 hind legs from 102 slaughtered fattening bulls were taken. Radiographic lesions in metatarsal growth plates were confirmed in selected cases using computed tomography (n=14) and histology (n=6). Radiographic criteria for growth plate lesions were axis deviations between the metatarsal bones and the digit, radiolucencies in the growth plate, increased bone density in the metaphysis, irregularities of the growth plate and marginal osteophytes («lipping»). The individual lesions were categorised as present/absent or 1 = slight, 2 = distinct, and 3 = severe. A weighted sum of these radiographic changes was generated for each growth plate and for each animal, and used for statistical analysis of the associations between husbandry factors and the occurrence of lesions. Almost all of the metatarsal bones had signs of osteochondral changes on the radiographs of the growth plates. The most common lesions were lipping (99,5 %), increased bone density in the metaphysis (66,6 %) and radiolucencies in the growth plates (64,1 %). Computed tomography and histology revealed hyperplasia of the margins of the epiphysis and metaphysis, focal increase in bone deposits accompanied by incomplete ossification and irregular and widened cartilage columns of the growth plate. There were statistically significant associations between the weighted radiographic changes and slaughter weight, average daily weight gain, husbandry practices and production label. The prevalence of radiographic lesions indicative for osteochondrosis of the metatarsal growth plates of fattening bulls slaughtered at a local abattoir was high. The extent to which the distinct and severe lesions are associated with reduced production and obvious clinical lameness requires further study. Die Prävalenz von osteochondrotischen Veränderungen in den Epiphysenfugen von Maststieren sollte anhand der Ossa metatarsalia postmortal dokumentiert werden. Dazu wurden 204 Hinterfüsse von 102 Maststieren gesammelt und röntgenologisch im plantarodorsalen Strahlengang untersucht. Bei ausgewählten Ossa metatarsalia wurden die Veränderungen computertomographisch (n=14) und histologisch (n=6) detaillierter dargestellt. Radiologische Kriterien für die Befundung waren Weichteilschwellung, Achsenabweichungen zwischen Röhrbein- und Zehenachse, Aufhellungen in der Wachstumszone, vermehrte Dichte des an die Epiphysenfuge angrenzenden Knochens, Regelmässigkeit und Weite der Epiphysenfugenlinien sowie knöcherne Ausziehungen («Lippenbildung») am Rande der Epiphysenfuge. Die Veränderungen wurden je nach Kriterium in vorhanden/nicht vorhanden oder 1 = schwach, 2 = deutlich und 3 = stark gewichtet. Aus den Befunden wurden gewichtete Röntgensummen der Veränderungen pro Metatarsus und pro Tier für die statistische Auswertung erstellt. Mit Hilfe dieser Röntgensumme wurde statistisch untersucht, ob ein Zusammenhang der Röntgenveränderungen mit verschiedenen Faktoren der Haltung bestand. Von den 204 Ossa metatarsalia wiesen nahezu alle röntgenologische Veränderungen im Sinne einer Osteochondrose an den Epiphysenfugen auf. Die häufigsten Befunde waren eine «Lippenbildung» (99,5 %), erhöhte Dichte des Knochengewebes nahe den Fugenlinien (66,6 %) und Aufhellungen in den Fugen (64,1 %). Die entsprechenden computertomographisch und histologisch nachweisbaren Veränderungen waren eine Hyperplasie des Randbereichs der Epiphyse und der Metaphyse, vermehrte Knochendichte bei unvollständiger Verknöcherung und eine Unregelmässigkeit sowie Verbreiterung der Säulenknorpelzone. Ein signifikanter Zusammenhang der gewichteten röntgenologischen Veränderungen mit dem Schlachtgewicht, mit der durchschnittlichen täglichen Gewichtszunahme, mit dem Produzenten sowie mit dem Produktionslabel war statistisch nachzuweisen. Zusammenfassend konnte röntgenologisch eine hohe Prävalenz von osteochondrotischen Veränderungen der Epiphysenfugen der Ossa metatarsalia von Maststieren aus dem Einzugsbereich des lokalen Schlachthofs festgestellt werden. Der Zusammenhang der deutlichen und insbesondere der starken Schädigungen mit einer reduzierten Mastleistung und einer klinischen Lahmheit bedarf weiterer Untersuchungen. La prévalence des modifications ostéochondrales des plaques de croissance métatarsiennes des taureaux à l’engraissement a été étudiée. Des radiographies planto-dorsales de la région métatarsienne de 204 membres postérieurs de 102 taureaux d’engraissement abattus ont été réalisées. Les lésions radiographiques des plaques de croissance métatarsiennes ont été confirmées dans des cas sélectionnés par tomodensitométrie (n=14) et histologie (n=6). Les critères radiographiques des lésions du cartilage de conjugaison étaient les déviations de l’axe entre les os métatarsiens et les phalanges, les radiotransparences du cartilage de conjugaison, l’augmentation de la densité osseuse de la métaphyse, les irrégularités du cartilage de conjugaison et les ostéophytes marginaux (« lipping »). Les lésions individuelles ont été classées comme présentes/absentes ou 1 = légères, 2 = distinctes et 3 = sévères. Une somme pondérée de ces modifications radiographiques a été générée pour chaque plaque de croissance et pour chaque animal et utilisée pour l’analyse statistique des associations entre les facteurs d’élevage et l’apparition de lésions. Presque tous les os métatarsiens présentaient des signes de modifications ostéochondrales sur les radiographies des plaques de croissance. Les lésions les plus fréquentes étaient le « lipping » (99,5 %), l’augmentation de la densité osseuse au niveau de la métaphyse (66,6 %) et les radiotransparences des plaques de croissance (64,1 %). La tomodensitométrie et l’histologie ont révélé une hyperplasie des marges de l’épiphyse et de la métaphyse, une augmentation focale des dépôts osseux accompagnée d’une ossification incomplète et des colonnes cartilagineuses irrégulières et élargies sur le cartilage de conjugaison. Il y avait des associations statistiquement significatives entre les changements radiographiques pondérés et le poids d’abattage, le gain de poids quotidien moyen, les pratiques d’élevage et les labels de production. La prévalence des lésions radiographiques révélatrices d’une ostéochondrose des plaques de croissance métatarsiennes des taureaux d’engraissement abattus dans un abattoir local était élevée. La mesure dans laquelle ces lésions distinctes et sévères sont associées à une production réduite et à une boiterie clinique évidente nécessite une étude plus approfondie. La prevalenza dei cambiamenti osteocondrali nelle articolazioni epifisarie dei tori da ingrasso doveva essere documentata, per questo studio, post-mortem utilizzando le ossa metatarsali. Sono state quindi raccolti ed esaminati radiograficamente 204 piedi posteriori di 102 tori da ingrasso nel percorso fascio plantarodorsale. Le lesioni delle ossa metatarsali sono state confermate in casi selezionati utilizzando la tomografia computerizzata (n=14) e l’istologia (n=6). I criteri radiografici dei risultati delle lesioni erano il gonfiore dei tessuti molli, la deviazioni dell’asse tra il metatarso e il piede, schiarimenti nella zona di crescita, aumento della densità dell’osso adiacente all’articolazione epifisaria, regolarità e larghezza delle linee dell’articolazione epifisaria così come estrazioni ossee («lipping») al bordo dell’articolazione epifisaria. Le singole lesioni sono state classificate come presenti/assenti o 1 = lievi, 2 = evidenti e 3 = gravi. Una somma ponderata di questi cambiamenti radiografici è stata generata per ogni metatarso e per ogni animale, e utilizzata per l’analisi statistica delle associazioni tra i fattori di allevamento e la comparsa delle lesioni. Tra le 204 ossa metatarsali raccolte, quasi tutte evidenziavano cambiamenti radiografici nel senso di osteocondrosi alle articolazioni epifisarie. Le lesioni più comuni erano il lipping (99,5 %), l’aumento della densità ossea vicino alle linee articolari (66,6 %) e gli schiarimenti nella zona di crescita (64,1 %). La tomografia computerizzata e l’istologia hanno rivelato un’iperplasia dei margini dell’epifisi e della metafisi, e un aumento focale dei depositi ossei accompagnato da un’ossificazione incompleta e colonne cartilaginee irregolari e allargate della placca di crescita. Sono state rilevate associazioni statisticamente significative tra i cambiamenti radiografici ponderati e il peso di macellazione, l’aumento di peso medio giornaliero, le pratiche di allevamento e l’etichetta di produzione. La prevalenza di lesioni radiografiche indicative di osteocondrosi delle placche di accrescimento metatarsali dei tori da ingrasso macellati in un mattatoio locale era alta. La misura in cui queste lesioni distinte e gravi sono associate a una produzione ridotta e a una zoppia clinica evidente richiede ulteriori studi.