Merck Manual

Please confirm that you are a health care professional

honeypot link

Freiberg Disease

(Freiberg Infraction)


Kendrick Alan Whitney

, DPM, Temple University School of Podiatric Medicine

Reviewed/Revised Oct 2021 | Modified Sep 2022
View Patient Education
Topic Resources

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.

Freiberg disease is a common cause of metatarsalgia Metatarsalgia Metatarsalgia is a general term for pain in the area of the metatarsophalangeal joints. (See also Overview of Foot and Ankle Disorders.) Most common causes include Freiberg disease Interdigital... read more . 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.

Bones of the foot

Bones of the foot

Symptoms and Signs of Freiberg Disease

In patients with Freiberg disease, 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.

Diagnosis of Freiberg Disease

  • 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.

How to Examine the Foot
How To Examine the Ankle

Treatment of Freiberg Disease

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

Corticosteroid injections and immobilization may help alleviate acutely painful flare-ups of Freiberg disease (see Considerations for using corticosteroid injections Considerations for Using Corticosteroid Injections Considerations for Using Corticosteroid Injections ). 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.

View Patient Education
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
quiz link

Test your knowledge

Take a Quiz!