Freiberg’s Infraction

Freiberg’s infraction is an osteochondrosis of the second metatarsal head in the foot.

Symptoms of a Freiberg’s infraction is typically pain under the second metatarsal (ball) of the foot. The patient usually has a longer second metatarsal or toe than the others and may have had previous stress fractures of this bone. There maybe an associated callous on the bottom of the foot where most of the pain is located.

Causes of Freiberg’s infraction is usually due to a longer second metatarsal. More often it is noticed in patients in there 2nd decade of life. As the bones are fully developed the effect of the longer metatarsal takes more of the weight while walking/running. Constant jamming and force on the bone and joint can cause mechanical stress with resulting stress fractures and/or joint damage. With repeated joint damage the cartilage and bone structure have a decreased blood supply and this tissue may necrose or die off (avascular necrosis). With necrotic (dead) bone the tissue undergoes changes such as flattening of the joint surface and the joint motion that produces pain with swelling. Other than heredity producing a longer metatarsal, trauma can also damage a joint setting it up for an avascular necrosis and Freiberg’s infraction.

Prevention of a Freiberg’s infraction are not completely possible as it may be linked to heredity due to the foot structure you were born with. If the area is irritated with redness, swelling, and pain some ice and anti-inflammatory medications may be helpful. The best prevention may be to get advice from your podiatrist.

Podiatric Care usually begins with x-ray evaluation of the foot and specifically the second metatarsal and the metatarsal-phalangeal joint. The podiatrist may see you to take care of any callouses that develop due to the pressure of a long metatarsal which has the same effect as a plantarflexed metatarsal. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure and balance the load across your metatarsals. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot. Anti-inflammatory oral medications or an injection of medication and local anesthetic may be used to reduce the pain and swelling.

Surgery to correct a Freiberg’s infraction is performed in different ways depending on the condition of the joint and bone. In some instances the joint may be salvaged and a clean up procedure is performed on the excess bone that has formed around the joint. Other instances the joint is totally removed and an implant is placed within the metatarsalphalangeal joint to act as a spacer.