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"Pain After Sigmoidoscopy"



Case of the Week 260

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



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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