Freiberg Infraction

Freiberg infraction refers to the collapse of subchondral bone with osteonecrosis involving the metatarsal head (usually the second or third). The joint may secondarily be affected by osteoarthritis.

It is felt to be related to acute or repetitive injury or to vascular compromise. High-heeled shoes are thought to be one causative factor and the condition is more common in women.

The image above shows flattening of the second metatarsal head with associated osteoarthritis.

MRI early in the course of the disease will show low T1 and high T2 signal in the metatarsal head. The main differential consideration at this point includes a stress reaction. Later in the course of the disease, there will be flattening of the metatarsal head with low T2 signal corresponding to sclerosis.

References

Ashman CJ, Klecker RJ, Yu JS. Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. Radiographics. 2001 Nov-Dec;21(6):1425-40.