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Freiberg's Infarction (Freiberg's Disease)

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Freiberg's disease is a rare condition affecting the second (or occasionally third) metatarsal head in the forefoot. It involves avascular necrosis — a loss of blood supply to the bone — resulting in collapse and degeneration of the joint surface. It typically affects adolescents or young adults, more commonly females.

Symptoms

• Pain in the ball of the foot, especially under the second toe
• Swelling or tenderness over the forefoot
• Stiffness or limited motion at the toe joint
• A sensation of walking on a stone
• Pain that worsens with walking, sports, or high heels

Diagnosis

Confirmed with X-rays showing flattening, fragmentation, or collapse of the metatarsal head. In early stages, MRI may detect changes before they are visible on X-ray.

Causes

• Repetitive stress or overload to the forefoot
• A longer-than-average second metatarsal
• Reduced blood supply to the metatarsal head
• Genetic predisposition
• Trauma during adolescence when growth plates are still open

Non-Surgical Treatment

• Activity modification — avoid impact sports and prolonged standing
• Stiff-soled or rocker-bottom shoes to limit joint motion
• Custom orthotics to offload the affected metatarsal
• Anti-inflammatory medications
• Immobilisation in a boot in some cases

Surgery

Surgery may be considered if symptoms persist or imaging shows joint collapse. Options include:

• Debridement and bone grafting to restore the metatarsal head shape
• Application of a chondrocyte matrix (cartilage scaffold) to encourage regeneration
• Shortening or elevation osteotomy to reduce joint loading
• Excision arthroplasty in very advanced cases

Recovery

Timeframe	What to Expect
0–2 weeks	Rest, foot elevated. Post-op shoe. Limited weight-bearing.
2–6 weeks	Wound review. Gradual walking and light physiotherapy.
6–12 weeks	Improved comfort. Return to supportive shoes.
3–6 months	Continued recovery. Custom orthotics in use.
6–18 months	Return to sport if healing is complete.