Freiberg's Disease
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Freiberg's disease is a rare condition in which the blood supply to the rounded end of a long bone behind one of your smaller toes is cut off. The bone then weakens and can flatten and collapse. It most often affects the second toe, then the third, and is seen mostly in teenage girls and young women, though it can happen at any age. The main symptom is pain in the ball of your foot that gets worse with activity. Early on, it often settles with rest from the activities that hurt, supportive shoes and shoe inserts. Surgery is needed only for some people.
What is it?
Freiberg's disease happens when the blood supply to the end of one of the long bones in your forefoot is disrupted. These bones are called metatarsals, and the rounded end that meets the toe is the metatarsal head. Without enough blood, that part of the bone dies (this is called osteonecrosis). The bone can then harden, flatten and collapse.
Over time, the damaged joint at the base of the toe can wear and develop osteoarthritis (a wearing of the joint surface). That is why early care matters.
It most often affects the second metatarsal, then the third. You may also hear it called Freiberg's infraction. Some sources use the name only for the second metatarsal, and others include the third and sometimes the fourth.
Who does it affect?
It is rare. One population study worked out that it affects about 1 in 2833 births.
It is seen mostly in adolescent and young females, and teenagers who play a lot of sport are often affected. It can also happen in adults and in males.
Signs and symptoms
The main symptom is pain in the ball of your foot, usually behind the second toe. The pain gets worse with activity, and standing or walking on the foot can hurt. You may also notice:
- swelling and tenderness at the front of your foot
- a grating or clicking feeling in the joint
- less movement in the toe joint
These signs can come from many foot problems, so they don't prove you have Freiberg's disease. Your podiatrist can work out what is going on.
What causes it?
The cause isn't known, so you haven't done anything wrong. The end result is that the blood supply to that part of the bone is disrupted, and the bone dies and crumbles.
The leading idea is that repeated stress on the forefoot, such as from running and jumping, damages the blood supply. Problems with blood vessels, family traits and the way your foot works may also play a part. A longer second metatarsal may take more load when you walk or play sport, but this isn't certain.
How is it diagnosed?
Your podiatrist will ask when the pain started, how long it has lasted, what makes it worse and whether you have noticed swelling or a change in your toes. They will look at your foot and press along the bones. They will also check how well your toe joints move and test the soft tissue under the joint.
Many things can cause pain in the ball of the foot, and they can feel alike. These include a stress fracture (a small crack in the bone), Morton's neuroma (a pinched nerve), a tear in the tissue under the joint, joint swelling, infection and arthritis. Because of this, your podiatrist shouldn't diagnose Freiberg's disease from your symptoms alone.
The usual test is an X-ray, and a view taken at an angle shows it best. Early on, the X-ray can look normal. If your podiatrist still suspects Freiberg's disease, you may need an MRI or a bone scan. Later X-rays show a flattened, broken-up bone end.
Treatment
The first step is almost always care without surgery. The aim is to take pressure off the affected bone so it can heal. In the early stages, the bone may heal and reshape by itself.
Looking after it at home
Cut back activities that flare the pain, such as running and jumping. Choose comfortable, well-padded shoes with plenty of room for your toes, and avoid high heels because they push more weight onto the front of your foot. A shoe with a wider, deeper toe box, a low heel and a stiffer, rocker-shaped sole can help.
If you are carrying extra weight, losing some can ease the load on your forefoot. Pain relief medicines, including anti-inflammatory ones, are sometimes used. Ask your pharmacist or doctor what suits you.
Treatment from your podiatrist
Your podiatrist can help you take the pressure off with shoe inserts (orthoses) and small pads placed behind the painful spot. They can also advise on footwear.
If your pain is bad, they may suggest a short period in a stiff-soled shoe, a short cast or a walking boot. In early stages this is often for 4 to 6 weeks. Some people use a boot or a cast below the knee while the bone heals.
These treatments are widely used, but they haven't been compared with each other, so no single one can be called best. Your podiatrist will tailor the plan to you and check your progress. If you aren't improving, they will plan the next step rather than carry on with the same care.
Other options
A steroid injection into the joint may give some relief in the early stages. Your doctor or specialist can talk to you about it.
Surgery
Surgery is usually considered only when care without surgery hasn't worked after about 6 months. It isn't needed for most people: in one children's leaflet, about 1 in 10 people needed it. Some surgeons keep it for more advanced disease. The choice of operation depends on your age, your activity, your goals and how the bone looks.
Surgery that keeps your own joint surfaces is more common and seems to give better results. More than 90 per cent of people having these operations had their pain go away and went back to full activity. For operations that remove or replace part of the joint, it was more than 70 per cent. These results come mostly from small, low-level reports, so they are a guide and not a promise.
For advanced disease, one option is to move a small plug of bone and cartilage from the knee to the damaged toe bone. This did better than cutting and tilting the bone (an osteotomy). It gave better toe movement and function, and fewer complications (1 per cent compared with 6 per cent). The cut-and-tilt operation shortened the bone by about 1.76 mm. The knee transfer can cause problems at the knee, in about 6.7 to 10.8 per cent of people.
All operations carry a risk of a stiff toe, a toe that sits up off the ground (a floating toe), or pain moving to the next toe bone. In one group of reports, about 5 per cent of people had a complication, most often pain.
Recovery
The outlook is generally good. If it is found and treated early, Freiberg's disease often settles without surgery. In the early stages, treatment usually carries on for at least 6 months before anyone thinks about an operation.
More advanced disease can leave the joint stiff or sore. In young people having surgery, results tended to be poorer when the bone damage was more advanced. Most people who have surgery report good pain relief.
It isn't yet clear how often Freiberg's disease comes back after treatment. If your pain returns or gets worse, go back to your podiatrist rather than waiting.
Preventing it
The disease isn't understood well enough to know how to prevent it. No one has shown that anything you do or don't do causes it.
What you can do is get ongoing pain in the ball of your foot checked early, because results seem better when it is treated early.
When to see a podiatrist
Book an appointment if
Book an appointment with your podiatrist if you have pain in the ball of your foot, often behind the second or third toe, that hasn't improved after 2 weeks of home care, or if it is limiting what you can do. Also book if the cause of your pain is unclear, treatment isn't helping, or the pain is getting worse. If you have diabetes and any foot pain, see your GP. See your GP too if you are no better after four weeks of looking after it yourself.
Seek prompt assessment if
This needs urgent medical assessment: see your GP today, or go to an urgent care clinic or the nearest emergency department. Do this if your foot suddenly changes shape, if you think you may have broken a bone or torn a tendon, or if you have severe pain that doesn't ease, a fever, weight loss you can't explain, or night pain that stops you sleeping. Do the same if a joint is hot, swollen and very painful, because a joint infection needs urgent help, or if swelling stays for no clear reason. If your symptoms get worse quickly after foot surgery, contact your surgeon urgently.
Frequently asked questions
Is Freiberg's disease the same as Freiberg's infraction?
Yes. Freiberg's infraction is another name for the same condition. You may also see it called osteochondrosis or osteonecrosis (bone death) of the metatarsal head, or avascular necrosis (bone death from a lost blood supply). Some sources use the name only for the second metatarsal, while others include the third and sometimes the fourth.
Can I keep playing sport?
Often you can stay active, but you may need to change or cut back the activities that bring on the pain while the bone heals. Your podiatrist can guide you on what suits your foot. How soon it is safe to go back to full sport isn't clear yet, so take it step by step and check in with your podiatrist.
Why does it affect more teenage girls?
The reasons aren't known. It is seen mostly in adolescent and young females, often those who play a lot of sport. It can also happen in males and in adults. Having it doesn't mean you did anything wrong.
What should I tell my podiatrist?
Tell them when the pain started, which activities bring it on and what eases it. Mention any swelling, and any change in the way your toes sit. Also say if anyone in your family has had foot problems, and what shoes you wear most. This helps them work out what is going on.