Presentation
Long distance runner. Acute onset of pain when running last night. Difficulty weight-bearing, and tender on palpation of midfoot. ?fracture ?stress fracture
Patient Data
Flattening of the third metatarsal head consistent with early osteochondrosis/Freiberg infraction. Preserved MTPJ. No fragmentation.
No acute fracture.
Case Discussion
This appearance is an important review area, especially with forefoot pain. Osteochondrosis (a.k.a. Freiberg infraction/disease) can typically affect the head of the second metatarsal, although the third and fourth have also been recognized as being affected.
No definitive etiology has been established, although in this case the repetitive trauma from long distance runner will have contributed. It is unclead what led to this acute presentation, given the relatively chronic appearance of the bone change.