Freiberg infraction

Case contributed by Dr Nicoletti Domenico Nicoletti

Presentation

Persistent pain and swelling of the MTP joint of the 2nd toe.

Patient Data

Age: 50 years
Gender: Female
x_ray

Radiological study shows discreet cortical sclerosis of the head of the 2nd metatarsal in the absence of focal lesions. There is also increased opacity of the surrounding soft tissues.

mri

MRI examination shows bone marrow edema of the 2nd metatarsal with evidence of small cortical defect in the metatarsal head. There is also diffuse edema of the interosseous muscles with some periarticular fluid.

Case Discussion

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

Possible causes include trauma, repeated mechanical stress, impaired blood supply and 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 the sport. Frequently there is localized pain on palpation and swelling at the level of the affected metatarsal head.

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

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