Clinical:
- A 30 years old man
- Active in sport
- Complains of chronic pain at right foot
- No swelling, no fever
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
Discussion:
- 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
