Some women have a congenital shorter first metatarsal bone compared to the second bone and because of this most of the weight stresses the head of the 2nd metatarsal bone (normally it is the head of the 1st metatarsal bone).
The first metatarsal bone is structurally equipped to deal with the normal pressure of the body weight, but the 2nd one isn’t.
Freiberg’s disease
This leads to an osteochondritis. The condition is known as Freiberg’s disease is more common in women and seems to be at least in part genetically transmitted. The symptoms are usually foot pain in the head of the 2nd metatarsal bone and the MP joint, which is made worse by the wearing of high heels.
Foot X-rays show the condition and treatment consists of padding under the painful toe. Occasionally the orthopedic surgeon orders immobilization in a short leg walking cast for 3 to 4 weeks. Surgery is only very rarely required.
Köhler’s disease
In another form of osteochondritis, called Köhler’s disease the naviclular bone is tender and swollen causing foot arch pain on the inside of the foot. This occurs mainly in young boys aged 3 to 5 where the gait is grossly abnormal due to pain in the foot. This tends to be a chronic disease, but usually clears up within two years.
There are stages in the healing process with initial flattening, then fragmentation and finally new bone growth. X-rays show these changes mentioned on one side, but not on the healthy opposite side. Treatment consists of rest, avoidance of weight bearing for a period of time and support of the longitudinal arch (with insoles) until new bone has formed.
References
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 5.
2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.
3. Wheeless’ Textbook of Orthopaedics: http://www.wheelessonline.com/
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 60, p.487.
5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
8. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
