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