Freiberg’s Disease

(Also known as Freiberg’s Infraction)

Freiberg’s Disease Overview

Freiberg’s disease is a rare condition that affects the second (or occasionally third) metatarsal head in the forefoot. It involves avascular necrosis—a loss of blood supply to the bone—resulting in collapse and degeneration of the joint surface.

It typically affects adolescents or young adults, more commonly females, and can result in chronic forefoot pain and joint stiffness if untreated.

Freiberg’s Disease Symptoms and Diagnosis

Symptoms typically include:

• Pain in the ball of the foot, especially under the second toe

• Swelling or tenderness over the forefoot

• Stiffness or limited motion at the toe joint

• A sensation of walking on a stone

• Pain that worsens with walking, sports, or high heels

Diagnosis is confirmed with X-rays, which show flattening, fragmentation, or collapse of the affected metatarsal head. In early stages, MRI may detect changes before they are visible on X-ray.

Freiberg’s Disease Causes

• Repetitive stress or overload to the forefoot

• A longer-than-average second metatarsal (index minus foot type)

• Reduced blood supply to the metatarsal head

• Genetic predisposition

• Trauma, especially during adolescence when growth plates are still open

Freiberg’s Disease

(Also known as Freiberg’s Infraction)

Freiberg’s Disease Overview

Freiberg’s disease is a rare condition that affects the second (or occasionally third) metatarsal head in the forefoot. It involves avascular necrosis—a loss of blood supply to the bone—resulting in collapse and degeneration of the joint surface.

It typically affects adolescents or young adults, more commonly females, and can result in chronic forefoot pain and joint stiffness if untreated.

Freiberg’s Disease Symptoms and Diagnosis

Symptoms typically include:

• Pain in the ball of the foot, especially under the second toe

• Swelling or tenderness over the forefoot

• Stiffness or limited motion at the toe joint

• A sensation of walking on a stone

• Pain that worsens with walking, sports, or high heels

Diagnosis is confirmed with X-rays, which show flattening, fragmentation, or collapse of the affected metatarsal head. In early stages, MRI may detect changes before they are visible on X-ray.

Freiberg’s Disease Causes

• Repetitive stress or overload to the forefoot

• A longer-than-average second metatarsal (index minus foot type)

• Reduced blood supply to the metatarsal head

• Genetic predisposition

• Trauma, especially during adolescence when growth plates are still open

Freiberg’s Disease Treatment and Prevention

Initial management is usually non-surgical and aims to reduce stress on the affected bone and joint:

• Activity modification (avoid impact sports, prolonged standing)

• Stiff-soled shoes or rocker-bottom soles to limit joint motion

• Custom orthotics to offload the affected metatarsal

• Anti-inflammatory medications (e.g. ibuprofen)

• In some cases, a period of immobilisation in a boot may be advised

Physiotherapy may be helpful to address any associated soft tissue tightness and improve overall foot mechanics.

Freiberg’s Disease Surgery

Surgery may be considered if symptoms persist despite conservative care or if imaging shows joint collapse or structural deterioration.

Surgical options include:

• Debridement and bone grafting of the metatarsal head to restore shape and reduce pain

• Application of a chondrocyte matrix (cartilage scaffold) to encourage surface regeneration

• Shortening or elevation osteotomy to reduce joint loading

• Excision arthroplasty in very advanced cases with joint surface destruction

Surgery is usually carried out as a day case under general anaesthetic.

Risks of surgery may include:

• Pain

• Infection

• Stiffness

• Scar formation

• Nerve injury

• Deep vein thrombosis (DVT) or pulmonary embolism (PE)

• Persistent symptoms

• Need for further surgery

Freiberg’s Disease Surgery Recovery

Following surgery, your foot may be placed in a post-operative shoe or boot, and weight-bearing may be limited for up to 6 weeks, depending on the type of procedure.

A wound check will be arranged at 2 weeks, and physiotherapy will follow to restore motion and strength. Custom insoles are often recommended long-term to protect the joint and offload stress.

Expected Recovery Timeline

0–2 weeks

Rest, foot elevated. Post-op shoe or dressing. Limited weight-bearing.

2–6 weeks

Wound review. Gradual walking and light physiotherapy.

6–12 weeks

Improved comfort and function. Return to supportive shoes.

3–6 months

Continued recovery with activity modifications. Custom orthotics in use.

6–18 months

Return to sport and full activity if healing is complete and pain is manageable.