Thompson and Hamilton type IV Freiberg's disease with involvement of multiple epiphyses of both feet

BMJ Case Rep. 2015 Feb 26:2015:bcr2014206909. doi: 10.1136/bcr-2014-206909.


A 17-year-old boy reported left second and third toe pain after axial loading injury to his left foot. Radiographs showed collapse of the second metatarsal heads and epiphysial irregularities of the fifth metatarsal heads and the condyle of the proximal phalanx of the hallux of both feet. The patient was diagnosed to have Thompson and Hamilton type IV Freiberg's disease. He was screened for epiphysial dysplasia of the other sites. He had on and off bilateral hip and knee pain. Radiographs showed bilateral symmetrical epiphysial abnormalities with morphological change as focal concavity in bilateral femoral heads and fragmentation of the patellar articular surface with preservation of the patellofemoral joint space.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Dietary Supplements
  • Epiphyses / abnormalities*
  • Epiphyses / diagnostic imaging*
  • Foot Orthoses
  • Glucosamine / therapeutic use
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Metatarsal Bones / abnormalities*
  • Metatarsal Bones / diagnostic imaging*
  • Metatarsophalangeal Joint / abnormalities*
  • Metatarsophalangeal Joint / diagnostic imaging*
  • Metatarsus / abnormalities*
  • Osteochondritis / classification
  • Osteochondritis / congenital*
  • Osteochondritis / diagnosis
  • Osteochondritis / therapy
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome


  • Anti-Inflammatory Agents, Non-Steroidal
  • Glucosamine

Supplementary concepts

  • Freiberg's disease