Freiberg’s Infraction

Aetiology

  • Idiopathic
  • Infraction means an incomplete fracture without displacement
  • Freiberg’s is an infraction of the dorsal part of a lesser toe MT head
  • The lower part of the head is preserved

Location

  • Descending from 2nd (most common) to 5th (least common)

Associations

  • Young adults
  • Freiberg’s is idiopathic but has been associated with:
    • Trauma
    • Repeated Stress e.g. high heels
    • Long metatarsal

Stages of Disease

  1. Subchondral Fracture
  2. Osteonecrosis of fractured fragment
  3. Deformation of necrotic area
  4. Arthrosis

Clinical Presentation

Symptoms

  • Well-localised pain
  • Non-progressive i.e. does not exponentially get worse
  • Pain is from arthrosis – osteophyte formation and synovitis
  • Mechanical in nature

XR

  • Typical features – widened deformed MT head
  • Lateral view shows sparring of inferior part of head

Management

Non-Operative

  • Problem will not get worse; therefore, no intervention for sake of prevention
  • Metatarsal bar insoles
  • Activity modification, NSAID and rest
  • Steroid Injection

Surgical Management

  • If intractable or functionally limiting pain
  • Options:
    • Debride Joint
    • Shorten MT +/- debride joint
    • Dorsiflexion osteotomy of MT head – most common procedure
      • Re-orientates MT head so necrotic part is extra-articularised
      • Fixed as a Weil’s osteotomy
      • Good results
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