Freiberg Infraction
Avascular Necrosis, Osteonecrosis, Osteochondrosis

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

Clinical findings

• Local pain, activity-related
• Tenderness
• Stiffness and limp

Imaging findings

• Early signs are sclerosis of 2nd MT head and widening of joint space
• Later there is fragmentation and collapse
• End result is flattening of head
• May produce “loose body”

Treatment

• Medical
  • Immobilization and avoidance of weight-bearing to rest the joint
• Surgical
  • Various osteotomies, bone grafts, excision of the head, joint replacement have each been used alone or in combinations

Complications        

• Premature closure of growth plate
• Loose bodies
• Secondary osteoarthritis

Other osteochondroses

• Kohler's disease of the tarsal navicular
• Panner's disease of the capitellum
• Sever's disease of the calcaneal apophysis
• Legg-Calve-Perthes disease of the capital femoral epiphysis
• Kienbock’s disease of the lunate
• Scheuermann’s disease of the spine