Freiberg's Infraction: Symptoms, Diagnosis And Treatment Approach

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Freiberg's infraction is an inflammatory condition that affects the second metatarsal, which is the thin bone that runs along the top of your foot and connects your ankle to your second toe. It occurs due to a loss of blood supply to the end of the metatarsal, and it's typically seen in children and teenagers during growth spurts when the metatarsal head comes under pressure, but it can also be caused by trauma and repetitive strain. Here's an overview of the symptoms, diagnosis and treatment approach:

Symptoms

Symptoms of Freiberg's infraction include the following:

• Pain at the end of the second metatarsal, which may worsen when your child's been on their feet
• Localised swelling, which may cause reddening of the surrounding tissue
• Stiffness of the front of the foot

Diagnosis And Treatment Approach

Your podiatrist will examine your child's foot and take note of their symptoms. In order to rule out other conditions that cause similar symptoms, such as a stress fracture or synovitis, they will arrange for your child to have a foot X-ray. If your child has Freiberg's infraction, the head of the second metatarsal will appear flat and fragmented on an X-ray.

The podiatrist will formulate a treatment plan based on the severity of your child's symptoms, and treatment may include the following:

Rest - In order for the inflammation to come down, your child must rest the affected foot as much as possible. There's no need for them to miss school, but they should refrain from playing sports and being on their feet any more than is necessary.

Medication - If the pain and swelling is severe, the podiatrist may suggest a short course of painkillers or anti-inflammatory medication to jump-start the healing process.

Orthotics - A custom-made orthotic insole that slips into your child's shoe will provide support and padding to the metatarsal. The insole will have a soft bar across the top of it that will protect the metatarsals and allow for healing to take place.

A Cast - To prevent further injury from knocks and overuse, a cast can be used for a couple of weeks to immobilise the foot, which can be particularly beneficial for young children who are unlikely to rest the foot or understand the need to do so.

Surgery - In rare cases when conservative treatment has not been effective, the podiatrist may recommend that the child be assessed for surgical debridement to revise the cartilage at the joint where the metatarsal meets the second toe.

If you're concerned you child has developed Freiberg's infraction, schedule a foot exam for them as soon as possible. 

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16 November 2016