Freibergs Disease


  • Freiberg’s disease is associated with pain in the forefoot.
  • It involves osteonecrosis of one of the metatarsal heads.
  • It usually occurs in adolescents or young teenagers that are growing.
  • Frieberg’s disease may also be referred to as Freiberg’s infarction or Freiberg’s infraction (a combination of infarction and fracture).

Diagnostic tips

  1. Swelling and localized tenderness associated with the involved toe.
  2. Metatarsophalangeal joint is often swollen and uncomfortable when it is palpated.
  3. Common associated with a long second toe (increase the repetitive force).

Tests and Imaging

  1. X-rays show a change in the shape of the affected metatarsal head and demonstrate that the associated metatarsal bone is long relative to the surrounding metatarsal bones.
  2. MRI may reveal evidence of fluid in the joint and significant bone edema in the metatarsal head.

Immediate Treatment

  1. Advise comfort shoes with metatarsal pad to help offload the area and for protection.
  2. Consider prescribing cam walker boot for protected weight bearing for a period of two to six weeks to allow the symptoms to settle.
  3. NSAIDs may be beneficial.

Possible Referral

  1. Podiatry for cam walker, comfort footwear and offloading orthoses/insoles.
  2. Orthopaedic foot surgeon for osteotomy.