Freiberg disease


  • A 30 years old man
  • Active in sport
  • Complains of chronic pain at right foot
  • No swelling, no fever
Radiograph of right foot in PA and oblique views

Radiographic findings:

  • Flattening and sclerosis of second metatarsal head
  • Presence of ostechondral fragment at affected bone
  • No fracture seen
  • Joint spaces are normal
  • No obvious soft tissue swelling

Diagnosis: Freiberg disease


  • Freiberg disease also known as freiberg infraction
  • Infraction is an obsolete term for non-displaced fracture
  • Named “infraction” because it was originally thought secondary to trauma
  • However, current theory suggested that it may be due to a combination of trauma, and vascular insults
  • Exact mechanism remains unknown but it is considered as one of the osteochondroses; diseases that usually affect the epiphyses of growing bones resulting in necrosis
  • It typically affects the 2nd metatarsal head, although the 3rd and  4th may also be affected.
  • It can be bilateral in up to 10% of cases.
  • Radiographic features include: sclerosis of 2nd metatarsal head and widening of joint space (early signs), later there is fragmentation and collapse, end result is flattening of head and may produce “loose body”
  • Bragard staging classification:
    • I – metatarsal head flattening and decreased subchondral bone density
    • II – metatarsal head sclerosis, fragmentation, and deformation, with cortical thickening
    • III – metatarsophalangeal osteoarthrosis with intra-articular loose bodies
Author: radhianahassan