Summary – Avascular neurosis of the 2nd or 3rd metatarsal head. This injury is due to repetitive stress to the metatarsal heads. This is most common in adolescent children (commonly girls). This is also common in active adolescents undertaking activity which increases load on the metatarsal heads. Pt will experience pain on pressure of the metatarsal head.
Differential diagnosis – stress fracture of metatarsal, plantar plate injury.
Diagnostic tip – adolescent female undertaking dance or very active adolescent. Pain of pressure of metatarsal head.
Testing or imagery – x-ray AP (if severe) show necrosis of met head know as “egg cup metatarsal”.
Referrals – Acute or moderate – Podiatry – padding and strapping to reduce pressure on metatarsal head, may require immobilisation. Require further offloading to prevent reoccurrence.
Severe – Orthopaedic surgeon – surgical opinion may be required for severe avascular neurosis.
Summary – freigbergs infraction is a condition that most commonly effects adolescent children undertaking extensive activity. This is very common in adolescent females who undertake dancing. This condition causes pain on pressure of the metatarsal head and most commonly effects the 2nd or 3rd digits.
How does this occur? – freigbergs infraction occurs due to increased pressure under the ball of the foot. This increased load places pressure under the metatarsal heads, which reduces the blood flow to the area and can cause the bone to start to degenerate and breakdown.
How can this be helped? – A podiatrist can undertake pressure removal through padding and strapping to help reduce further degeneration and allow the metatarsal heal as quickly as possible. In severe cases immobilisation maybe required, orthopaedic surgeon consolt maybe also be required.
Who can help? – A podiatrist, Orthopaedic surgeon.