Freiberg infraction

Case contributed by Dr Domenico Nicoletti

Presentation

Female patient with persistent pain and swelling of the metatarsal phalangeal joint of the second toe.

Patient Data

Age: 50
Gender: Female
Modality: X-ray

Radiological study detects modest cortical sclerosis of the head of the second metatarsal in the absence of focal lesions. There is also increasing the opacity of the surrounding soft tissue.

Modality: MRI

MRI examination shows bone marrow edema of the 2nd metatarsal with evidence of small cortical defect at the level of the head. It also appreciates diffuse edema of the interosseous muscles along with modest amounts of periarticular fluid. Are within the limits of the flexor and extensor tendons.

Case Discussion

Freiberg's disease is a pathological condition painful forefoot, which usually affects teenage girls who practice dance and ballet. The exact etiology is unknown, but the disease is often associated with alterations in ossification of the second metatarsal head.

Possible causes include trauma, repeated mechanical stress, impaired blood supply, the use of unsuitable footwear. Less than 10% of patients have bilateral involvement. The pain is aggravated by the load of the body weight and from sport. At the level of the affected metatarsal head are frequent localized pain on palpation and swelling.

Plain radiographs may show sclerosis and varying degrees of flattening of the articular surface involved. In the majority of patients a non-surgical treatment, comprising modification interventions of physical activity, the use of insoles of footwear metatarsal and well padded facilitates the regeneration of the metatarsal head and the resolution of symptoms.

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Case Information

rID: 29096
Case created: 3rd May 2014
Last edited: 26th Sep 2015
Tag: crop
Inclusion in quiz mode: Included

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