Comprehensive Column on Freiberg Infarction: Etiology, Pathophysiology, Imaging, and Management
Introduction Freiberg infarction, also known as Freiberg disease or osteochondrosis of the metatarsal head, is a relatively rare yet clinically significant condition affecting the forefoot. It is characterized by avascular necrosis and subchondral bone collapse, predominantly involving the second and third metatarsal heads. Its understanding is crucial for clinicians, radiologists, and orthopedic surgeons due to its subtle early presentation and progressive impact on foot biomechanics if untreated. Case Overview (Reference Case) A 63-year-old active woman presented with severe left forefoot pain following running. She had a notable history of a healed fifth metatarsal base fracture. Initial weight-bearing X-ray showed no acute fractures ([Figure 1]). MRI without intravenous contrast revealed pronounced bone marrow edema of the third metatarsal head consistent with Freiberg infarction ([Figure 2]). Cause and Etiology Freiberg infarction is multifactorial, involving repetitiv...
