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Freiberg Disease

(Freiberg's Disease; Freiberg Infraction)

By Kendrick Alan Whitney, DPM, Associate Professor, Department of Biomechanics, Temple University School of Podiatric Medicine

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Freiberg disease is avascular necrosis of the metatarsal head. Pain is most pronounced with weight bearing. Diagnosis is confirmed with x-rays. Treatment includes corticosteroid injections, immobilization, and orthotics.

Bones of the foot.

Freiberg disease is a common cause of metatarsalgia. Freiberg disease is caused by microtrauma at the metaphysis and growth plate. Avascular necrosis flattens the metatarsal head. The 2nd metatarsal head is most often affected. Freiberg disease is thought to occur more frequently among pubertal females and among people who have a short 1st metatarsal bone or long 2nd metatarsal bone, which increases stress on the 2nd metatarsal head and joint. The metatarsal joint tends to collapse, and activities that repetitively stress this joint, such as dancing, jogging, or running, may accelerate this process.

Symptoms and Signs

The pain is most pronounced in the forefoot at the metatarsal head with weight bearing, particularly when pushing off or when wearing high-heeled footwear. The metatarsophalangeal joint may also be swollen and have limited and painful passive range of motion.


  • X-rays

The diagnosis of Freiberg disease is confirmed with x-rays. Typically, the head of the 2nd metatarsal is widened and flattened, and the metatarsal joint is sclerotic and irregular.


  • Immobilization and weight unloading if acute, then modification of footwear

Corticosteroid injections and immobilization may help alleviate acutely painful flare-ups. Long-term management of Freiberg disease may require orthoses with metatarsal bars and low-heeled footwear, possibly with rocker sole modifications, to help reduce stress on the 2nd metatarsal head and joint. Rarely, surgical excision of the metatarsal head may be necessary to relieve recalcitrant pain.

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