CORE DECOMPRESSION AS A NOVEL TREATMENT FOR EARLY FREIBERG'S INFRACTION OF THE SECOND METATARSAL HEAD

Orthopedics ◽  
1995 ◽  
Vol 18 (12) ◽  
pp. 1177-1178
Author(s):  
Andrew A Freiberg ◽  
Richard A Freiberg
Keyword(s):  
Core Decompression ◽  
Metatarsal Head ◽  
Novel Treatment ◽  
Second Metatarsal ◽  
Freiberg’S Infraction

Osteochondral Disruption of the Second Metatarsal: A Variant of Freiberg's Infraction?

Foot & Ankle ◽  
1987 ◽  
Vol 8 (2) ◽  
pp. 103-109 ◽  
Author(s):  
M. Christine Young ◽  
Victor L. Fornasier ◽  
Hugh U. Cameron
Keyword(s):  
Articular Cartilage ◽  
Plantar Flexion ◽  
Metatarsal Head ◽  
Necrotic Bone ◽  
Second Metatarsal ◽  
Metatarsophalangeal Joints ◽  
Type Of Injury ◽  
Freiberg’S Infraction ◽  
Compression Type ◽  
Made In

A case of Freiberg's Infraction of the second metatarsal is presented. The metatarsal head was resected and its pathology proved very informative. Necrotic bone was not found, but a shearing type of separation was identified at the level of “tidewater mark” in the articular cartilage and was the major observation. This suggested the possibility that in adults Freiberg's Infraction rather than true avascular necrosis may be in fact the result of a shearing-compression type of injury occurring at the interface between mineralized and nonmineralized articular cartilage (tidewater mark). An anatomical examination of metatarsophalangeal joints in cadavers showed that during walking at the “toe off” position, the toes dorsiflex to force the metatarsal head into plantar flexion. The proximal phalanges ride dorsally over the metatarsal heads producing a shearing force that would support our interpretation of the observations made in the case presented.

Freiberg's infraction in a collegiate heptathlete

2000 ◽  
Vol 90 (2) ◽  
pp. 77-80 ◽  
Author(s):  
HJ Palamarchuk ◽  
CR Oehrlein
Keyword(s):  
Conservative Treatment ◽  
Metatarsal Head ◽  
Etiologic Agent ◽  
Direct Trauma ◽  
Second Metatarsal ◽  
Custom Made ◽  
History Of ◽  
Freiberg’S Infraction

In 1914, Freiberg described a condition of infraction of the second metatarsal head. At the time, he considered direct trauma to be the etiologic agent, but he later disproved this by demonstrating a case without a history of trauma. This article describes a case of Freiberg's infraction in a female collegiate heptathlete and the effects of conservative treatment of her condition with custom-made orthoses.

Unusual osteochondral fracture of the second metatarsal head in a paediatric patient treated with bioabsorbable pin

2021 ◽  
Vol 14 (2) ◽  
pp. e238376
Author(s):  
Hafiz Muhammad Umer ◽  
Hafiz Javaid Iqbal ◽  
Raghuram Thonse
Keyword(s):  
Paediatric Patient ◽  
Metatarsal Head ◽  
Management Options ◽  
Osteochondral Fracture ◽  
Second Metatarsal ◽  
Paediatric Case

Osteochondral second metatarsal head fractures are rare. Various management options have been described in the published literature. We used bioabsorbable pin (Activa Pin) system for our case of second metatarsal head fracture. This method not only achieves good compressive fixation, it also eliminates the risk of implant-related issues such as implant irritation. To our knowledge, no such paediatric case managed with this technique has been published in the literature.

Autologous Osteoligamentous Reconstruction of Scaphoid Proximal Pole With Metatarsal Head and Collateral Ligament: Cadaver Anatomic Description of Novel Surgical Technique

Hand ◽  
2020 ◽  
pp. 155894471989561
Author(s):  
Christopher G. Larkins ◽  
Shruti C. Tannan ◽  
Alison E. Burkett ◽  
Suhail K. Mithani ◽  
Ramesh C. Srinivasan ◽  
...  
Keyword(s):  
Lateral Collateral Ligament ◽  
Metatarsal Head ◽  
Cadaver Study ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Collateral Ligament ◽  
Cadaveric Specimen ◽  
Simultaneous Reconstruction ◽  
Second Metatarsal ◽  
Fresh Frozen

Background: Historically, scaphoid nonunion has been surgically treated with vascularized bone graft taken from multiple different anatomic sites. However, none of these grafts fully recapitulate the unique osteoligamentous anatomy of the proximal pole of the scaphoid and the attachment of the scapholunate ligament (SLIL). We studied the anatomy of the vascularized second metatarsal head with its lateral collateral ligament as a potential novel treatment of proximal pole scaphoid nonunion with collapse. Methods: Scaphoids and second metatarsal heads were harvested from bilateral upper and lower extremities of 18 fresh frozen cadavers (10 male, 8 female) for a total of 36 scaphoids and 36 second metatarsal heads. The ipsilateral second metatarsal head was harvested with its lateral collateral ligament and its blood supply from the second dorsal metatarsal artery (SDMA). Measurements of the scaphoid, the SLIL, the second metatarsal head, and lateral collateral ligaments were compared to matched limbs from the same cadaver. Results: The anatomic dimensions of the second metatarsal head with its lateral collateral ligament are similar to the scaphoid proximal pole and the SLIL in matched cadaveric specimen. Conclusions: This anatomic cadaver study reveals that the second metatarsal head with its associated lateral collateral ligament is a well-matched donor to reconstruct the proximal pole of the scaphoid and SLIL. This anatomic similarity may be well suited to treat nonunion of the scaphoid proximal pole with or without avascular necrosis with simultaneous reconstruction of the SLIL. The authors describe a technique of vascularized reconstruction of the osteoligamentous proximal pole of the scaphoid with its attached SLIL utilizing autologous second metatarsal head with its attached lateral collateral ligament. Based on this cadaver study, this technique merits consideration.

Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

2016 ◽  
Vol 38 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Jun Young Choi ◽  
Yu Min Suh ◽  
Ji Woong Yeom ◽  
Jin Soo Suh
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

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.

Effect of Orthotic Therapy on Claw Toe Loading

2004 ◽  
Vol 94 (3) ◽  
pp. 246-254 ◽  
Author(s):  
Penny J. Claisse ◽  
Jodi Binning ◽  
Julia Potter
Keyword(s):  
Pressure Measurement ◽  
Plantar Pressure ◽  
Metatarsal Head ◽  
Plantar Surface ◽  
Time Integral ◽  
Pressure Time ◽  
Second Metatarsal ◽  
Plantar Pressure Measurement ◽  
Access To Data ◽  
Toe Deformity

This study demonstrates the effect of orthotic therapy for toe deformity on toe and metatarsal head pressures using a new analysis method facilitated by an in-shoe pressure-measurement system’s ability to export detailed data. Plantar pressure–time integrals in 11 individuals (22 feet) with claw deformity of the lesser toes were measured with and without toe props. Differences in pressure–time integrals at every individual sensor unit were then calculated for the two conditions, and significance was tested using the paired t-test. Plantar surface charts with contours of equal significant pressure–time integral change showed significant reduction under 17 second toes (77%), 22 third toes (100%), 15 fourth toes (68%), 13 second metatarsal heads (59%), 16 third metatarsal heads (73%), and 16 fourth metatarsal heads (73%). All 22 feet showed increases under the prop in the area of the third toe sulcus. This innovative approach to plantar pressure analysis could improve access to data that show significant pressure–time integral changes and, therefore, could advance the clinical application of plantar pressure measurement. (J Am Podiatr Med Assoc 94(3): 246–254, 2004)

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