What is Freiberg’s disease?

There are many different causes for pain in the ball of the foot. A less common cause is a condition known as Freiberg’s disease or infarction. This is a condition where the head of a metatarsal bone which is at the base of the toes in the ball of the foot becomes weaker and has micro fractures. It most commonly affects the 2nd and 3rd metatarsals, though they all can be affected. It is believed to be caused by repeated microtrauma to the metatarsals heads which cause a localised lack of blood flow to the area. The metatarsal heads then become weaker and collapses. Freiberg’s disease mostly occurs in younger athletes over about the age of 12, and more commonly affects young females more than young males. The microtrauma appears to come from overloads and particularly in sports that involve a lot of sprinting, jumping or weight bearing on the forefoot. Wearing non supportive or non-cushioning footwear may contribute to underlying pressure on the metatarsal bones.

The typical symptoms include increasing pain overlying the affected metatarsal head. There is typically a swelling and bruising surrounding the affected area. The pain will worsen with increase weightbearing activities. Usually there will be a decreased range of motion at the affected toe joint with pain present on movement of the affected toe. Limping to offloading the affected foot is also common. The diagnosis of Freiberg’s disease is made by a health care practitioner and is based on several features such as a full clinical assessment which will include a biomechanical assessment and gait analysis. There will be a review of the full pain history and medical history assessment to rule out any other causes for the symptoms. The joint range of motion will be assessed, and a physical palpation of the area will be done. The definitive diagnosis is usually done by x-ray and this typically shows a flattening to the metatarsal head, looking like a crushed egg shell in the most severe cases.

The treatment of Freiberg’s disease starts with rest and immobilisation of the area for up to six weeks. This is required in the early part of treatment for to allow the micro fracture site to heal. The immobilisation is often done with a moon boot or cam walker prescribed by a health practitioner. Foot orthotics may be used to reduce the painful symptoms of Freiberg’s disease. The aim of the foot orthotics is to achieve this by off loading the area and also with some re-aligning of the foot. They need to provide support to the painful area and are often used following that initial period of immobilization. A steel or carbon fibre plate can also often be used to make the shoe stiffer. This means that there is less flexion or bending of the shoe in the forefoot and this reduces stress on the area. Non steroidal anti-inflammatory medications such as ibuprofen may be given for pain relief and to reduce inflammation. If this does not help then a surgical repair of the fracture site may be required to repair the damage.