Freiberg's Disease

What is Freiberg's disease?

Freiberg's disease is a condition where the head of one of the metatarsal bones in the forefoot, most often the second, loses its blood supply temporarily. The bone weakens and can flatten or fragment over time.

It's most often seen in adolescents, particularly girls, and the precise cause isn't fully understood. Repetitive overload, individual variation in blood supply, and biomechanical factors all probably contribute.

Like other osteochondroses, Freiberg's evolves through phases. Identified early, it can often be managed without surgery; later-stage disease with significant joint damage may need a different approach.

What does it feel like?

Common features include:

• Pain in the ball of the foot, typically under the second toe

• Pain worse with activity, particularly running and jumping

• Sometimes swelling over the forefoot

• Pain when pushing off during walking

• A sense of stiffness or restricted movement at the toe joint

Symptoms can develop gradually and may have been present for some time before assessment.

How is it diagnosed?

Examination identifies pain at the typical location. X-rays usually show the changes in the metatarsal head, flattening, fragmentation or other features depending on the stage.

MRI is useful in earlier stages when X-ray changes haven't yet developed, or when the picture is atypical.

Assessment also considers the foot shape and any biomechanical contributors that might affect both treatment and prognosis.

What are the treatment options?

Earlier-stage Freiberg's often responds to rest from aggravating activities, orthotic support to offload the affected metatarsal, and sometimes a brief period of immobilisation. Many cases settle with conservative management.

Later-stage or persistent cases sometimes need surgical intervention, options range from joint-preserving procedures to more involved reconstruction depending on the specifics. Nev will work through what's right for your child at your consultation.

When should you get it checked?

Seek a specialist assessment if:

• There's persistent pain in the ball of the foot

• Pain is interfering with activity or sport

• There's swelling or tenderness over a specific spot in the forefoot

• Conservative measures haven't helped

• You want a clear diagnosis and plan

Freiberg's disease is uncommon enough to be sometimes underrecognised, but with the right diagnosis, it's a manageable condition and most young people do well with the right plan.