What's the most likely diagnosis?

• 18 year-old female with pain in foot

1. Osteoarthritis
2. Gout
3. Freiberg's infraction
4. Hallux valgus
5. Hammer toes

Answer:

 

3. Freiberg's infraction

 

 

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Freiberg's Infraction

General considerations

• Named “infraction” because it was originally thought secondary to trauma
• Exact cause remains uncertain but thought to be one of the osteochondroses in adolescents
  • Osteochondroses are diseases that usually affect the epiphyses of growing bones resulting in necrosis most likely on a vascular basis, although the exact mechanism is not known
• In others, Freiberg's may be due to a combination of trauma, and vascular insults
• Relatively uncommon
• Painful collapse of the head of the 2nd metatarsal
  • May affect 3rd metatarsal head as well
• Women to men by 5:1
  • Possibly because of shoes, i.e. stresses placed on toe by high-heeled shoes
    • Length of second metatarsal thought to be a factor by some
  • Usually adolescents
• Almost always unilateral

 

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