Freiberg Infraction - MSK Radiology Imaging Findings: • Sclerosis of the 2nd MT head with flattening of the articular surface and concavity of the metatarsal head. Widening of the MTP joint space. • T1-hypointense signal with flattening and concavity of the metatarsal head articular surface. • Hyperintense subchondral edema-like signal of the 2nd MT head. Case description: • Controversy: Subchondral fracture and/or osteonecrosis of metatarsal head. • Most common location 2nd MT head, less likely 3rd MT head. • Predisposing factors include: Short 1st MT, hallux valgus, and high-heels. • Pain worsens with weight-bearing. • Flattened MT head in isolation NOT DIAGNOSTIC. Look for secondary signs. • Unstable 2nd MTP joint can mimic Freiberg infraction. Differential diagnosis for similar location of pain: • Plantar plate injury: Dorsal MTP subluxation, torn plantar plate, subchondral bone edema. • Intermetatarsal bursitis: T2-hyperintense fluid-collection between metatarsal heads. • Morton Neuroma: Enhancing fusiform mass between MT heads. Dr. Donald von Borstel @DrvonBorstel #Freiberg #Infraction #foot #clinical #mri #clinical #Radiology #diagnosis #msk
