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Podiatrist Santa Monica: tarsal coalition

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Metatarsal Avascular Necrosis | Freiberg's Infarction

What is Frieberg's Infarction and Avascular Necrosis

Frieberg’s infarction or avascular necrosis of a metatarsal head is a problem that is commonly misdiagnosed and a cause of pain for patients. There are several advances in the treatment of Frieberg’s disease that are offered by the Foot and Ankle Institute that have helped revolutionize the treatment of this difficult problem.

What Causes Frieberg's Infarction and Avascular Necrosis:  

The cause of the problem is not fully understood but seems to be due to chronic micro-trauma and overload of the metatarsal head leading to fracture and collapse of the metatarsal head and decreased or loss of circulation to the collapsed area. Over time, arthritis and pain develop.

X-ray of normal metatarsal head X-ray showing long second metatarsal with avascular necrosis and Freiberg's infarction
X-ray showing a normal second metatarsal head. X-ray showing an AVN of the second metatarsal head. Notice the collapsed of the bone and the destruction of the joint.
Surgical picture showing avascular necrosis of 2nd metatarsal head and Freiberg's infarction
Picture of an AVN of the second metatarsal head. Notice the missing cartilage on the end of the bone.

Avascular Necrosis and Frieberg's Infarction Treatment Options:

Conservative care for Frieberg’s infarction is through offloading of the area. During the active period of pain and early collapse, the patient is often placed in a boot or cast and on crutches to limit or completely remove weight from the metatarsal head. With time, an orthotic is made to decrease the abnormal pressure through the metatarsal head.

If there is collapse and early arthritis noted, three procedures are used to salvage the joint. The first is to remove all loose bone and spurs in the joint. In more advanced cases, the spurs are removed and the metatarsal head is shortened to decrease the abnormal stress going through the area. In cases of more advanced cartilage damage, the cartilage from the bottom of the joint is tilted upwards to resurface the joint and remove the damage cartilage on the top of the joint.

Pre--operative x-ray showing avascular necrosis of the 2nd metatarsal head with degenerative joint disease Surgical picture showing degenerative joint disease and avascular necrosis of metatarsal head with metatarsal tilt up osteotomy
X-ray showing a damaged 2nd toe joint. Picture showing the bone cut made to decompress the joint.
Post-operative x-ray of tilt up osteotomy for treatment of avascular necrosis and Freiberg's infarction Drilling of the metatarsal head cartilage damage area for fibro-cartilage formation
X-ray showing the pins that hold the bone cut in the new position with the healed joint. Picture showing the drill holes made into the bone to facilitate new cartilage growth.

In severe cases of arthritis, the metatarsal head is removed and the area is either filled with a tendon graft or an implant is used to resurface the joint. This new resurfacing technique has allowed rapid recovery and dramatic improvement in pain and function.

Pre-operative x-ray of cartilage damage to 2nd metatarsal head with avascular necrosis Post-operative x-ray of 2nd metatarsal head implant for the treatment of avascular necrosis Freiberg's infarction with cartilage damage
X-ray showing damaged joint prior to surgery. X-Ray showing a joint implant in the 2nd toe joint.

University Foot and Ankle Institute is one of only a few centers in the world experienced in resurfacing of the metatarsal head. We have extensive experience with avascular necrosis of metatarsal heads and cater our treatment to the individual needs and goals of the patient. Request an appointment at one of our Los Angeles or other Southern California offices, we can help!

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877-677-0011

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