Freiberg's infraction is a condition of cartilage degeneration (osteonecrosis) of the lesser metatarsal heads -
first described in 1914 by Alfred H. Freiberg
adolescent females are the "textbook" patients - however both males and females may present with this condition later in life
second and third metatarsals are the most commonly affected, while involvement of the fourth and fifth is rare
more common in patients whose first metatarsal is shorter than the second metatarsal, which increases the weight on the second metatarsal head
incidence is higher in females than in males
pathophysiology is unknown, but studies suggest a combination of vascular compromise, genetic predisposition, and altered biomechanics
diagnosis is made clinically and imaging is used to confirm
clinical presentation
forefoot pain - generally affecting head of the second metatarsal
there is irritation of the joint
generally associated with physical activity
the head of the metatarsal is palpable and tender
may be localised swelling and stiffness in the metatarsophalangeal joint
patient may have an antalgic gait
conditions in the differential include stress fracture, synovitis, Morton's neuroma and osteosarcoma
early in the process, radiographs are normal however bone scans may demonstrate a photopenic center with a hyperactive collar
as Freiberg's infraction progresses, radiographs show a flattened and fragmented metatarsal head
magnetic resonance imaging can reveal hypointensity of the metatarsal head
management
nonoperative treatment is based on decreasing foot pressure and unloading the affected metatarsal. Spontaneous healing with remodeling may occur in early stages of the disease
operative options are dorsal closing wedge osteotomies, osteochondral transplant, and resection arthroplasty
outcomes of nonoperative and operative management are good to excellent and most patients are able to return to previous activity (1)
Reference:
Talusan PG et al. Freiberg's infraction: diagnosis and treatment. Foot Ankle Spec. 2014 Feb;7(1):52-6.
Freiberg AH; Infraction of the second metatarsal bone, a typical injury, Surg Gyn Ob, 1914, 19:191.
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