732.5 Juvenile osteochondrosis of foot Calcaneal apophysitis Epiphysitis, os calcis Osteochondrosis (juvenile) of: astragalus (of Diaz) calcaneum (of Sever) foot NOS metatarsal: second (of Freilberg) fifth (of Iselin) os tibiale externum (of Haglund) tarsal navicular (of Köhler)
Frieberg’s Infarction Etiology / Epidemiology / Natural History
AVN of the 2nd metatarsal head. Can involve other metatarsal heads.
more common in females, and adolesents.
Can heal with only minimal deformity, or continue with progressive degenerative changes and articular destruction.
Frieberg’s Infarction Anatomy
Frieberg’s Infarction Clinical Evaluation
Pain at the affecte MTP joint, usually aggravated by activity.
May have swelling, and limited range of motion.
Usually occurs in adolescence,
Frieberg’s Infarction Xray / Diagnositc Tests
A/P, latera and oblique views of foot. May be normal in early stages. Show progressive deformities in the metatarsal head, with irregularity, fragmentation, and flattening in late stages.
Bone scan: non-specific, may localize the pathologic process to the metatarsal head.
MRI: shows changes consistent with avascular necrosis.
Frieberg’s Infarction Classification / Treatment
Acute: stiff-soled shoe or short-leg walking cast. Consider intra-articular corticosteroid injection for temporary pain relief.
Chronic: joint exploration, synovectomy, and debridement of bone fragments and osteophytes. Extensive deformity may require a Du Vries arthroplasty. If the volar joint is well preserved, consider a distal metatarsal Moberg type osteotomy (dorsal closing wedge at the level of the metatarsal neck approximately 1 inch proximalto the joint, which results in dorsiflexion of the metatarsal head.)