Freiberg infraction: osteochondrosis of the metatarsal heads (typically the 2nd metatarsal head) characterized pathologically by subchondral bone collapse, osteonecrosis, and cartilaginous fissures
- Freiberg infraction is more common in women and most commonly manifests during adolescence (aged 10-18 years). Bilateral presentation in 10% of cases. Cause unkown and probably multi-factorial. High-heeled shoes have been implicated as a causative factor
- Patients may present with pain and limited motion, although symptoms may not begin until degenerative arthrosis has developed.
1913 – Albert Freiberg presented a paper to the Southern Surgical and Gynecological Association. He reported six cases of young women presenting with a painful limp and discomfort localized to the second metatarsal. First described case from 1903. [1914;26:171-174]
1915 – Alban Köhler described in his book:
“One sometimes finds in the roentgenogram at the site complained of, a joint-space of double breadth, where the second or third metatarsals, or both, articulate with the toes. There is a definite proximal displacement of the end of the metatarsal involved. There is as yet no description of this finding in the literature. The author has seen altogether 4 or 5 cases. It is obvious that this finding is pathologic, but the author is not aware of the cause or the nature of the disease.‘ [‘Grenzen des Normalen und Anfänge des Pathologischen in der Radiologie des kindlichen und erwachsenen Skeletts’ – 1915]
1926 – Numerous other cases were reported between 1915 and 1924. Köhler called out Freiberg for an ‘incomplete‘ description of ‘metatarsal infraction‘ lacking mention of the widening of the joint line; thickening of the shaft of the metatarsal and obliteration of the neck. Freiberg responded in 1926 acknowledging trauma unlikely to be the sole cause and the additional features as suggested by Köhler…
- Freiberg disease
- Freiberg infraction
- Köhler disease II
- Freiberg-Köhler syndrome
Infraction, not infarction. Freiberg believed the aetiology most likely was trauma possibly due to the excessive length of the second metatarsal with overload and subsequent articular collapse
- Freiberg AH. Infraction of the second metatarsal – a typical injury. Transactions of the Southern Surgical and Gynecological Association 1914;26:171-174.
- Köhler A. Eine typische Erkrankung des 2. Metatarsophalangealgelenkes. Munchener medizinische Wochenschrift, 1920, Vol. 67, pp. 1289-1290 [Typical disease of the second metatarsophalangeal joint. Translation: American journal of roentgenology. 1923, 10: 705-710]
- Freiberg AH. The so-called infraction of the second metatarsal bone. J Bone Joint Surg 1926; 8: 257-61.
- Ashman CJ et al. Forefoot Pain Involving the Metatarsal Region: Differential Diagnosis with MR Imaging. Radiographics. 2001;21:6:1425-1440
- Katcherian DA. Treatment of Freiberg’s disease. Orthop Clin North Am. 1994 Jan;25(1):69-81. [PMID 8290232]
- Binek R, Levinsohn EM, Bersani F, Rubenstein H. Freiberg disease complicating unrelated trauma. Orthopedics. 1988 May;11(5):753-7. [PMID 3399446]
- Torriani M, Thomas BJ, Bredella MA, Ouellette H. MRI of metatarsal head subchondral fractures in patients with forefoot pain. AJR Am J Roentgenol. 2008 Mar;190(3):570-5. [PMID 18287423]
- Scartozzi G, Schram A, Janigian J. Freiberg’s infraction of the second metatarsal head with formation of multiple loose bodies. J Foot Surg. 1989 May-Jun;28(3):195-9. [PMID 2696742]
- Cerrato RA. Freiberg’s disease. Foot Ankle Clin. 2011 Dec;16(4):647-58. [PMID 22118235]