MRI demonstrates subchondral insufficiency fracture in the head of the second metatarsal, evidenced by curvilinear hypointensity on the proton density image (image 1), with adjacent reactive marrow edema. The articular surface of the metatarsal head is congruent and the second metatarsophalangeal joint is in anatomic alignment. There is reactive edema in the adjacent soft tissues. No loose bodies are present.
The patient underwent conservative management of symptoms. Oblique radiograph of the left foot performed two years later demonstrates flattening and mild concavity of the head of the second metatarsal, progressed from the previous MRI. There is a small osseous projection from the medial aspect of the head of the second metatarsal, reflecting sequelae of subchondral collapse, which is characteristic of the diagnosis. No osteochondral loose body is present.
- Freiberg disease/infraction
- Normal variant, flattened morphology of the head of the metatarsal 正常变异
- Fracture of metatarsal head or neck 跖骨头或颈骨折
- Rheumatoid arthritis 类风湿性关节炎
- Osteochondral fracture versus osteonecrosis of the head of a metatarsal (most frequently the second metatarsal) with progressive subchondral collapse.
- Bilateral disease in approximately 10% of cases.
- Chronic repetitive trauma is the favored theory. Compression and altered biomechanics from shoes (i.e., heels) have been postulated, given the female predilection.
- Primary avascular necrosis also has been proposed.
- Early disease
- Cystic changes and flattening of the head of the metatarsal
- Widening of the metatarsophalangeal joint
- Late disease
- Osteochondral fragmentation/defect
- Sclerosis of the head of the metatarsal
- Cortical thickening
- Smillie classification system
- Stage I: Fissure fracture of the ischemic epiphysis
- Stages II to V: Increasing stage with worsening severity of subchondral collapse
- Stage IV: Presence of osteochondral loose body
- Stage V: Osteoarthritic change
- There is a female gender predilection (3:1 ratio to male patients)
- Peak age is 10 to 18 years (adolescents青少年).
- Patients present with pain, edema, and decreased range of motion of the affected metatarsophalangeal joint.（疼痛、肿胀、跖趾关节活动度下降）
- Symptoms are worsened with weight-bearing.（负重时症状加重）
- Widening of the metatarsophalangeal joint is seen in the early phase of the disease.
- Sclerosis and cystic changes are seen in the head of the metatarsal.
- Radiographs shows progressive flattening and concavity of the articular surface of the head of the metatarsal (central articular surface is typically affected first).
- Loose body can be seen in late disease.
- MRI demonstrates marrow edema (T2-hyperintense, T1 hypointense signal) in the head of the metatarsal.
- Serpentine T2 hypointense in the subarticular/subchondral region.
- Sclerosis in the later phase of the disease will be T2 hypointense.
- Normal variant, flattened morphology of the head of the metatarsal
- Fracture of metatarsal head or neck
- Rheumatoid arthritis
- Carmont MR, Rees RJ, Blundell CM. Current concepts review: Freiberg\’s disease. Foot Ankle Int. 2009;30(2):167-176.
- Stanley D, Betts RP, Rowley DI, Smith TW. Assessment of etiologic factors in the development of Freiberg\’s disease. J Foot Surg. 1990;29(5):444-447.
- Talusan PG, Diaz-Collado PJ, Reach JS Jr. Freiberg\’s infraction: Diagnosis and treatment. Foot Ankle Spec. 2014;7(1):52-55.