Freiberg’s Disease: The Surprising Cause of Forefoot Pain
When patients experience pain in the ball of the foot, it’s often assumed to be a result of poor footwear, overuse, or a common condition like plantar plate injury or metatarsalgia. However, in rare cases—particularly in adolescents and young adults—Freiberg’s Disease could be the underlying cause.
This lesser-known condition can be easily misdiagnosed, but with the right assessment and management, patients can return to pain-free activity.
What is Freiberg’s Disease?
Freiberg’s Disease (also known as Freiberg’s Infraction) is a form of avascular necrosis that affects one of the long bones in the forefoot—typically the second metatarsal head. Avascular necrosis means the blood supply to the bone is compromised, causing parts of the bone to die and collapse over time.
The condition usually presents during adolescence, especially in physically active girls, but can also affect adults. Repetitive stress on the forefoot, such as from dancing, netball, gymnastics, or running, may play a role in its development.
Signs and Symptoms
Pain in the forefoot, often over the second toe joint
Swelling or tenderness at the base of the second toe
Difficulty wearing heels or tight shoes
Limping or reduced activity due to pain
In some cases, stiffness or locking of the toe joint
Because these symptoms can mimic other forefoot conditions, imaging—particularly X-rays or MRI—is critical for accurate diagnosis.
What Causes It?
The exact cause isn’t fully understood, but contributing factors include:
Repetitive microtrauma to the metatarsal head
Vascular compromise during bone development
Mechanical overload from a long second metatarsal or high-arched feet
Hormonal influences during growth spurts
How is Freiberg’s Disease Diagnosed?
At Bondi Podiatry, we assess gait, foot mechanics, and localised tenderness. Diagnostic imaging helps us see early changes in the bone structure and joint surface—X-rays may reveal flattening or fragmentation of the metatarsal head.
Treatment Options
Early stage Freiberg’s Disease can often be managed without surgery. Treatments may include:
Activity modification to reduce impact loading
Custom orthotics to offload the affected metatarsal
Stiff-soled shoes or rocker-bottom footwear
Anti-inflammatory treatment or temporary immobilisation
Physical therapy to maintain joint mobility
For later-stage disease, where there is joint degeneration or persistent pain, referral for surgical consultation may be warranted. Surgical options might include debridement, bone grafting, or joint reconstruction depending on the extent of damage.
Why It’s Important to Act Early
If caught early, Freiberg’s Disease has a good prognosis with conservative treatment. Delaying care may lead to irreversible joint damage, chronic pain, and reduced mobility.
At Bondi Podiatry, we don’t just treat common foot conditions—we’re trained to spot rare and complex cases too.
📍 You can find us at 301/251 Oxford Street, Bondi Junction
📞 Book your appointment today on (02) 8971 1682 or book online
If you or your child are experiencing forefoot pain that isn’t improving, don’t brush it off—it could be something more than just “growing pains.”
