(See also Overview of Foot and Ankle Disorders.)
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.
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.