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Frieberg’s Infarction M92.70 732.5

 
ICD-9 Classification / Treatment
Etiology / Epidemiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:2nd metatarsal head osteonecrosis, Frieberg's infarction

Frieberg’s Infarction ICD-10

Frieberg’s Infarction ICD-9

  • 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

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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.)

Frieberg’s Infarction Associated Injuries / Differential Diagnosis

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Frieberg’s Infarction Complications

  • Claw toe
  • Monoarticular nontraumatic synovitis
  • Morton's Neuroma
  • Metatarsophalangeal joint instability
  • Plantar Keratosis
  • Cock-up fifth toe

Frieberg’s Infarction Follow-up Care

  • Short-leg walking cast for 4 weeks.
  • Switch to stiff-soled shoe at 4 weeks.

Frieberg’s Infarction Review References

  • Sproul J, Jlaaren H, Mannarino F: Surgical treatment of Frieberg’s infarction in athletes. AJSM 1993;21:381-384.
  • Herring JA: Disorders of the foot, in Herring JA (ed): tachdjian’s ed 3, 2002 pp 891-1038f
  • Mizel MS JAAOS 1995;3:166