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Skeletal Radiol 2019 Jan 31. Epub 2019 Jan 31.

Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.

Subchondral insufficiency fracture (SIF) is a non-traumatic condition that has historically been associated with elderly, osteoporotic women and patients with systemic conditions. There has been much work done to determine the pathogenesis of SIF, which has previously been regarded as idiopathic, rapid-progressive osteoarthritis or osteonecrosis of the hip, spontaneous osteonecrosis of the knee (SONK), osteochondral defect (OCD) of the talus and adult-onset Freiberg infraction of the metatarsal head. Early diagnosis and management are crucial to prevent subchondral collapse, secondary osteonecrosis and early-onset osteoarthritis. Read More

Foot Ankle Clin 2019 Mar 26;24(1):17-33. Epub 2018 Nov 26.

Radiology and (by courtesy) Orthopedics and Bioengineering, Department of Radiology, Stanford University, 1201 Welch Road, Room P-263, Stanford, CA 94305, USA. Electronic address:

Avascular necrosis of the foot and ankle is a rare but important cause of pain and functional abnormality. This process may occur in any bone in the foot and ankle; however, it presents most often in characteristic locations. Understanding of key radiographic findings is important in management of these lesions. Read More

Radiol Clin North Am 2018 Nov;56(6):877-892

Department of Radiology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA. Electronic address:

Although causes of metatarsalgia are multifactorial, in practice these most commonly include osseous stress reaction or fracture (including subchondral injury) and interdigital neuroma or plantar plate tear with adjacent pseudoneuroma. The various roles of radiography, ultrasonography, and MR imaging are discussed, and relevant technical issues and imaging findings are reviewed in order to facilitate accurate diagnosis and guide proper treatment of metatarsalgia. Read More

J Orthop Case Rep 2015 Jul-Sep;5(3):12-4

Family and Community Medicine & Sports Medicine, Texas Tech University Health Sciences Center 3601 4th Street Lubbock, TX 79430.

Introduction: Freiberg infraction is a relatively rare osteochondrosis of the metatarsal head. The etiology of Freiberg infraction is poorly understood but likely involves factors such as, repetitive trauma and vascular compromise. When discovered early, Freiberg infraction can be cured with conservative measures but late presentations require surgical intervention. Read More

Foot Ankle Spec 2015 Dec 19;8(6):498-519. Epub 2015 May 19.

Unlabelled: Avascular necrosis of the second metatarsal head was first described by Freiberg in 1913. Conservative treatment includes nonsteroidal anti-inflammatory medication, reduced activity, padding, orthotics, and immobilization. Should conservative treatment fail, a wide variety of surgical procedures exist; however, the optimal procedure is unknown. Read More

Foot Ankle Spec 2014 Feb 5;7(1):52-6. Epub 2013 Dec 5.

Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.

Freiberg's infraction is a condition of cartilage degeneration of the lesser metatarsal heads. Adolescent females are the "textbook" patients but both males and females may present with this condition later in life. The second and third metatarsals are the most commonly affected, while involvement of the fourth and fifth is rare. Read More

Clin Podiatr Med Surg 2013 Jul;30(3):313-25

Orlando Foot and Ankle Clinics, 250 North Alafaya Trail, Suite 105, Orlando, FL 32825, USA.

Pain in the second metatarsophalangeal joint (MTPJ) is a complaint frequently encountered by foot and ankle specialists. The pathology associated with this joint is often painful and debilitating for the patient. In the past, typical treatment protocols for second MTPJ pathology were aimed at relief of patient symptoms. Read More

Am J Orthop (Belle Mead NJ) 2011 Apr;40(4):183-91

Boston VA Healthcare System, Boston, Massachusetts 02130, USA.

The predominance of several musculoskeletal foot conditions in women are largely the result of biomechanical alterations caused by ill-fitting shoes. In particular, the altered biomechanics (associated with high-heeled shoes and shoes with a narrowed toe box) has been linked to the genesis of hallux valgus, hammer toe deformity, Haglund syndrome, metatarsal stress fracture, Freiberg infraction, and Morton neuroma. In reviewing the imaging findings of several of these conditions, we emphasize the role of radiographs, special radiographic views, and the utility of more costly studies, such as magnetic resonance imaging. Read More

Adolesc Med State Art Rev 2007 May;18(1):182-91, xi

Department of Orthopaedics, Ohio State University, Columbus Children's Hospital, 3rd Floor, Education Building, 700 Children's Drive, Columbus, OH 43205, USA.

The treatment of foot problems in the adolescent should be nonsurgical whenever possible. Surgical treatment should be considered when medical treatment does not relieve pain. Surgical corrections to prevent problems in adulthood may cause complications and lead to an undesirable outcome. Read More

J Foot Ankle Surg 2005 May-Jun;44(3):218-21

Department of Orthopedic Surgery, Kaiser Permanente, Santa Rosa, CA, USA.

Freiberg's infraction is an ostechondrosis of a lesser metatarsal head resulting in degeneration of the metatarsophalangeal joint. Several mechanisms have been suggested in its pathenogenesis. Freiberg first described the entity and believed single impact trauma was the underlying cause. Read More

Radiographics 2001 Nov-Dec;21(6):1425-40

Department of Radiology, Ohio State University Medical Center, S209 Rhodes Hall, Columbus, OH 43210, USA.

Many disorders produce discomfort in the metatarsal region of the forefoot. These disorders include traumatic lesions of the soft tissues and bones (eg, turf toe, plantar plate disruption, sesamoiditis, stress fracture, stress response), Freiberg infraction, infection, arthritis, tendon disorders (eg, tendinosis, tenosynovitis, tendon rupture), nonneoplastic soft-tissue masses (eg, ganglia, bursitis, granuloma, Morton neuroma), and, less frequently, soft-tissue and bone neoplasms. Prior to the advent of magnetic resonance (MR) imaging, many of these disorders were not diagnosed noninvasively, and radiologic involvement in the evaluation of affected patients was limited. Read More

J Am Podiatr Med Assoc 2000 Feb;90(2):77-80

Department of Orthopedics, Temple University School of Podiatric Medicine, Philadelphia, PA 19107, USA.

In 1914, Freiberg described a condition of infraction of the second metatarsal head. At the time, he considered direct trauma to be the etiologic agent, but he later disproved this by demonstrating a case without a history of trauma. This article describes a case of Freiberg's infraction in a female collegiate heptathlete and the effects of conservative treatment of her condition with custom-made orthoses. Read More

Orthopedics 1995 Dec;18(12):1177-8

Department of Surgery, University of Michigan Hospitals, Ann Arbor, Mich, USA.

Orthopedics 1988 May;11(5):753-7

Department of Radiology, SUNY Health Science Center, Syracuse, NY 13210.

Freiberg's infraction is an avascular necrosis of the metatarsal head characterized by the development of disorderliness of chondrogenesis and osteogenesis in previously normal bone. Radiographic findings follow the pathological progression of bony changes. The presented cases document the development of avascular necrosis in a previously normal metatarsal that occurred after trauma or surgery elsewhere in the foot. Read More