Freiberg’s Disease Involving Third Metatarsal Bone Noted by Bone Scan: A Case Report

Received 11/2/2006; revised 1/17/2007; accepted 1/18/2007. For correspondence or reprints contact: Bing-Fu Shih, M.D., Division of Nuclear Medicine, Mackay Memorial Hospital. 92 Section 2, Chung-Shan North Road, Taipei 104, Taiwan. Tel: (886)2-25433535 ext.2241, Fax: (886)2-25433535 ext.2925, E-mail: [email protected] Bone scan is a sensitive tool for evaluating cause of bone pain in symptomatic patients especially when other clinical or imaging modalities can not provide enough information for diagnosis. A 64-year-old woman visited our orthopedic department complaining of left foot pain without other signs or symptoms. Due to persistent pain which was unresponsive to treatment and unexplained by X-ray finding of fracture, the patient underwent a whole body bone scan. The scintigraphic finding showed focally increased radiotracer uptake at the third left metatarsal bone especially in the head region. In view of clinical history, there was long-term repetitive stress on the patient’s feet; therefore, we suggested the possibility of aseptic necrosis (Freiberg’s disease). Finally, a biopsy was done and the pathology revealed osteonecrosis of the third left metatarsal bone. Our case demonstrates an uncommon site of osteonecrosis with a typical pattern of radiotracer uptake which assisted in the diagnosis of osteonecrosis. Furthermore, bone scan serves as an initial and non-invasive role in determining the need for further management.