Summary
- 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
- Swelling and localized tenderness associated with the involved toe.
- Metatarsophalangeal joint is often swollen and uncomfortable when it is palpated.
- Common associated with a long second toe (increase the repetitive force).
Tests and Imaging
- 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.
- MRI may reveal evidence of fluid in the joint and significant bone edema in the metatarsal head.
Immediate Treatment
- Advise comfort shoes with metatarsal pad to help offload the area and for protection.
- Consider prescribing cam walker boot for protected weight bearing for a period of two to six weeks to allow the symptoms to settle.
- NSAIDs may be beneficial.
Possible Referral
- Podiatry for cam walker, comfort footwear and offloading orthoses/insoles.
- Orthopaedic foot surgeon for osteotomy.
