Freiberg‘s Infraction

2019 ◽  
Vol 24 (4) ◽  
pp. 669-676
Author(s):  
Hans-Jörg Trnka ◽  
Javier Serrano Lara
Keyword(s):  
Freiberg’S Infraction

scholarly journals Patient Outcomes Following Polyvinyl Alcohol Hydrogel Implant of the Lesser Metatarsals

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0016
Author(s):  
Bopha Chrea ◽  
Jonathan Day ◽  
Stephanie K. Eble ◽  
Andrew J. Elliott ◽  
Martin J. O’Malley ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Polyvinyl Alcohol ◽  
Case Series ◽  
Metatarsal Head ◽  
Persistent Pain ◽  
Osteochondral Defects ◽  
Joint Pathology ◽  
Freiberg’S Infraction ◽  
Pva Hydrogel

Category: Lesser Toes; Other Introduction/Purpose: Lesser toe metatarsal phalangeal (MTP) joint pathology presents a challenge for surgical treatment. Recently, synthetic cartilage implants have been shown to be safe and efficacious in treating hallux ridigus, offering pain relief while preserving motion at the MTP joint. At our institution, metatarsophalangeal joint arthroplasty using a polyvinyl alcohol (PVA) hydrogel implant has been utilized in the 2nd and 3rd MTP joints for advanced arthritis, failed management of Freiberg’s infraction, and osteochondral defects. We present a case series describing the clinical outcomes of 12 patients following PVA implantation of the 2nd or 3rd MTP. Methods: We retrospectively identified 12 consecutive patients (13 joints) who underwent PVA hydrogel implantation of the 2nd (n=12) or 3rd (n=1) metatarsal head between 2017 and 2019. PVA implant was indicated for advanced arthritis in 6 patients (7 joints), Freiberg’s infraction in 4 patients, and osteochondral defect in 2 patients. Average age was 51 years (range, 20-67), with 100% females. Patient-reported outcomes measurement information system (PROMIS) scores were collected preoperatively and at latest follow-up, with an average follow-up of 20.4 months (range, 8.3 to 29.2). Retrospective chart review was performed to evaluate postoperative complications, including need for revision, implant removal, and persistent pain. Results: Overall, patients demonstrated mean improvement in all PROMIS domains, with a significant improvement in Pain Intensity of 11.9 points (p=0.03) postoperatively. A total of 4 postoperative complications occurred in the 12 patients: one case of AVN at 2 years postoperatively, one revision with removal of the implant and bone grafting of the second metatarsal head at 1 year postoperatively, one periprosthetic fracture at 9 months postoperatively, and one recurrence of pain requiring ultrasound- guided injection at 7 months postoperatively. Three additional patients reported persistent pain postoperatively. Conclusion: This study represents the largest case series to date evaluating the use of PVA hydrogel implant in the surgical correction of lesser toe MTP joint pathology. While the PVA implant presents a viable option in the setting of advanced arthritis, Freiberg’s infraction, and certain osteochondral defects, it is not without complications. The specific indications for use of the PVA implant should be carefully considered before implantation.

Joint Debridement and Metatarsal Remodeling in Freiberg’s Infraction

2013 ◽  
Vol 103 (3) ◽  
pp. 185-190 ◽  
Author(s):  
Mehmet Erdil ◽  
Yunus Imren ◽  
Kerem Bilsel ◽  
Ayhan Erzincanli ◽  
Murat Bülbül ◽  
...  
Keyword(s):  
Health Survey ◽  
Short Form ◽  
Metatarsal Head ◽  
Advanced Stage ◽  
Foot And Ankle ◽  
Short Form Health Survey ◽  
Form Health ◽  
American Orthopaedic ◽  
Freiberg’S Infraction ◽  
Short Form Health

Background: Freiberg’s infraction is an osteochondrosis that is characterized by osteonecrosis of the metatarsal head, with pain and tenderness around the metatarsophalangeal joint. We sought to evaluate the outcome of joint debridement and metatarsal remodeling for the treatment of advanced-stage Freiberg’s infraction. Methods: Between March 1, 2006, and April 30, 2011, 14 patients (eight females and six males) with symptomatic unilateral Freiberg’s disease refractory to conservative treatment (Smillie stages IV and V) underwent joint debridement with metatarsal head remodeling by two surgeons. To evaluate functional outcome, American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey forms were completed by the patients preoperatively and postoperatively at months 3, 6, and 12. Active-assisted range-of-motion exercise was allowed after 4 weeks of short-leg walking cast wear, and weightbearing on the forefoot was allowed as tolerated. Results: Mean patient age was 27.0 years (range, 16–53 years), and mean follow-up was 40.2 months (range, 14–54 months). Mean ± SD American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey scores were 46.8 ± 8.95 and 28.9 ± 4.3 preoperatively and 76.2 ± 9.5 and 45.6 ± 7.7 1 year after surgery, respectively. There was a significant increase in both scores (P ≤ .001). Conclusions: In advanced-stage Freiberg’s infraction of the second metatarsal, joint debridement and metatarsal head remodeling is a safe and simple therapeutic option, and it provides better quality of life for patients. (J Am Podiatr Med Assoc 103(3): 185–190, 2013)

Early Epiphyseal Fusion in Freiberg's Infraction

Foot & Ankle ◽  
1983 ◽  
Vol 3 (5) ◽  
pp. 297-298 ◽  
Author(s):  
Elias D. Sedlin
Keyword(s):  
The Third ◽  
Epiphyseal Fusion ◽  
Epiphyseal Closure ◽  
Freiberg’S Infraction

A case of Freiberg's Infraction of the third metatarsal which demonstrates early epiphyseal closure in this condition is presented. The etiology of this phenomenon is unclear.

Freiberg's infraction: a case from medieval Kent

The Foot ◽  
1995 ◽  
Vol 5 (4) ◽  
pp. 202-203
Author(s):  
T Anderson ◽  
A.R Carter
Keyword(s):  
Freiberg’S Infraction

Outcomes of Polyvinyl Alcohol Hydrogel Implant of the Lesser Metatarsals

2020 ◽  
Vol 41 (9) ◽  
pp. 1092-1098
Author(s):  
Bopha Chrea ◽  
Jonathan Day ◽  
Stephanie K. Eble ◽  
Andrew Elliott ◽  
Martin J. O’Malley ◽  
...  
Keyword(s):  
Polyvinyl Alcohol ◽  
Clinical Outcomes ◽  
Case Series ◽  
Measurement Information ◽  
Osteochondral Defects ◽  
Level Of Evidence ◽  
Joint Pathology ◽  
Patient Reported ◽  
Freiberg’S Infraction ◽  
Pva Hydrogel

Background: Lesser toe metatarsophalangeal (MTP) joint pathology presents a challenge for surgical treatment. At our institution, arthroplasty using a polyvinyl alcohol (PVA) hydrogel implant has been utilized in the second and third MTP joints for advanced arthritis, failed management of Freiberg’s infraction, and osteochondral defects. We present a case series describing the clinical outcomes of 13 patients following PVA implantation of the second or third MTP. Methods: We retrospectively identified 13 patients (14 joints) who underwent PVA hydrogel implantation of the second ( n = 12) or third ( n = 2) metatarsal between 2017 and 2019. The average age was 49 (range, 20-67) years, with 100% females. Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected preoperatively and at an average of 21.1 (range, 8.3-29.2) months postoperatively. Clinical outcomes were also evaluated. The average time to clinical follow-up was 24.7 (range, 7-35.8) months. Results: On average, patients demonstrated pre- to postoperative improvement in all PROMIS domains, with significant improvements in Pain Intensity ( P = .01) and Pain Interference ( P = .01). Five postoperative complications were observed: 1 case of persistent avascular necrosis, 1 revision with implant removal and bone grafting, 1 periprosthetic fracture, and 2 recurrences of pain requiring ultrasound-guided injection. Conclusion: This study represents the largest case series to date evaluating the use of PVA implant in the surgical correction of lesser toe MTP joint pathology. While the PVA implant presents a viable option in the setting of advanced arthritis, Freiberg’s infraction, and certain osteochondral defects, it is not without complications. The specific indications for use of the PVA implant should be carefully considered. Level of Evidence: Level IV, case series.

FREIBERG'S INFRACTION

Orthopedics ◽  
1996 ◽  
Vol 19 (3) ◽  
pp. 201-201
Author(s):  
Peter F Merkle
Keyword(s):  
Freiberg’S Infraction

Forefoot Pain in a Female College Soccer Player

2003 ◽  
Vol 12 (3) ◽  
pp. 272-279
Author(s):  
Todd A. Evans ◽  
Sharon N. Domorski ◽  
Wayne J. Sebastianelli ◽  
Margot Putukian ◽  
Jay N. Hertel
Keyword(s):  
Differential Diagnosis ◽  
Soccer Player ◽  
Weight Bearing ◽  
Signs And Symptoms ◽  
Athletic Participation ◽  
Subsequent Treatment ◽  
Division I ◽  
Forefoot Pain ◽  
Common Complaint ◽  
Freiberg’S Infraction

Idiopathic forefoot pain, often termed metatarsalgia, is a common complaint among running athletes. Whereas several causes are often included in the differential diagnosis, Freiberg’s infraction is rarely considered. The signs and symptoms present with Freiberg’s infraction however, can mimic those present with more common forefoot injuries. The article presents the case of a female Division-I college soccer player who developed and was successfully treated for bilateral Freiberg’s infraction. Her initial complaint of unilateral forefoot pain, induced only by vigorous running, progressed to intolerable bilateral forefoot pain with light exercise. Conservative treatment was unsuccessful, and therefore surgery was required to enable her continued athletic participation. As with all weight-bearing joints, clinicians need to be aware of the potential for progressive degenerative changes at the metatarsal heads and the steps used in the evaluation and subsequent treatment of Freiberg’s infraction

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