A patient has presented this week with pain in the forefoot. The pain was marked and typical for generalised forefoot pain. Her recent treatment has focused on a ‘neuroma’ or ‘bursitis’. The treatment interventions have been unsuccessful, and she was referred to me.
On examination, her pain was solely focused around a slightly enlarged 2nd MTPJ. Radiographs and ultrasound had not identified any issues. However, when I inspected the X-rays the 2nd metatarsal head looked slightly imperfect.
The patient subsequently had a CT and Freiberg’s infraction was observed. On the images it can be seen how the 2nd metatarsal head is indented and has an early sign of Freiberg’s infraction.
The patient has been unresponsive to conservative treatment and is keen to move towards surgical intervention. These conditions respond well to a capsular interpositional arthroplasty. Frieberg’s is not common, however, it should be kept in mind during your differential diagnosis.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
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Remember functional anatomy and to x-ray
(This content is intended for healthcare professionals only)