07/03/2013    

QUERIES (CLINICAL)

Query: Freiberg's Infraction in 47 Year Old Male

My patient is a 47 year old male who complains of pain in his 1st and 2nd MPJ. He is disabled due to a seizure disorder following partially successful neurosurgery for brain tumor (no tumor recurrence), but he has seizures and memory issues, but could otherwise be considered healthy. He thinks his foot problem started a few years ago, but doesn't recall anything specific. He walks for exercise. Attempting to move the 2nd MPJ through any ROM is uncomfortable. His 1st MPJ has limited ROM as well, although it looks good on x-ray. He has a lot of swelling, more so than I would expect.

Freiberg's Infraction in 47 Year Old Male

1. Would you image this (MRI) to rule out bone neoplasm, or be satisfied with biopsy during surgery? 2. I have had reasonably good results debriding bone from the 2nd metatarsal head, and in some cases removing the base of the phalanx, or resecting the metatarsal head for the worst cases. Would you offer any other surgical treatment for this?