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Freiberg Disease

(Freiberg Infraction)

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

Freiberg disease is death of the tissue (necrosis) of parts of the bones in the ball of the foot, usually next to the big toe (the second metatarsal head).

Freiberg disease is a common cause of pain in the ball of the foot (metatarsalgia). The cause is injury to the bone. This disorder usually occurs in girls who are going through puberty and who are growing rapidly or in people in whom the bone connected to the base of the big toe (the first metatarsal bone) is short or the second metatarsal bone is long. In both cases, the second metatarsal head can be subjected to repeated stresses such as during dancing, jogging, or running.


Pain is usually worse when bearing weight, particularly when pushing off of the foot, or when wearing high-heeled shoes. The joint may be swollen and stiff.


  • X-rays

Doctors do x-rays to confirm the diagnosis of Freiberg disease.


  • Corticosteroid injections

  • Footwear changes or orthoses

  • Rarely surgery

To relieve painful flare-ups, doctors may inject corticosteroids and tell people to rest and keep weight off their foot.

Low-heeled shoes, possibly those that have thicker soles than normal and rounded heels (called rocker sole modifications), or inserts or other devices placed in the shoe that change the position or range of movement of the foot to relieve pressure on the affected joints or painful areas (orthoses) are helpful.

Rarely, doctors may surgically remove the second metatarsal bone to relieve pain that is difficult to manage.

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