Freiberg Disease

Freiberg disease is a painful foot condition characterized by disrupted blood supply to the joint surface (metatarsal head) of the second metatarsal bone—located next to the big toe—resulting in joint damage and stress fractures.

It is more common in adolescent females and typically diagnosed through physical examination and X-rays. Treatment depends on the stage of the disease. In early stages, rest, activity modification, and anti-inflammatory medications are often sufficient. In more advanced stages, if there is persistent pain and deformity of the toe, surgical treatment may be necessary.

What Is Freiberg Disease?

Freiberg disease affects the second metatarsal bone of the foot, specifically at the joint area called the metatarsal head, which articulates with the toe. Although the exact cause is not fully understood, it is believed to result from reduced blood flow to the metatarsal head. This leads to cartilage deterioration over time, causing pain and deformity in the second toe.

What Causes Freiberg Disease?

Freiberg disease is a form of avascular necrosis—a condition where the blood supply to bone tissue is disrupted—commonly affecting the second or third metatarsal heads. It occurs most often in adolescents and young adults, particularly females.

Common causes include:

• Excessive load or repetitive microtrauma

• Structural abnormalities in foot anatomy

Who Is at Risk for Freiberg Disease?

This condition is most commonly seen in female athletes aged 13 to 18. The female-to-male ratio is approximately 4:1. People with an unusually long second toe are also at greater risk.

Symptoms of Freiberg Disease

Pain, swelling, and stiffness at the base of the second toe are the most common symptoms. These symptoms tend to worsen with physical activity.

Key signs include:

• Pain and tenderness over the metatarsal head

• Swelling and limited range of motion in the foot

These may indicate a serious case of Freiberg disease. Early diagnosis and treatment are crucial. You can contact us through our communication channels or WhatsApp button for more information.

How Is Freiberg Disease Diagnosed?

An experienced orthopedic surgeon may suspect Freiberg disease based on the patient's medical history and physical examination. X-rays are typically used to confirm the diagnosis. However, in the early stages, Freiberg disease might not appear on X-rays and MRI imaging may be required to detect early changes.

Staging of Freiberg Disease

Freiberg disease is classified into five stages based on radiological findings:

• Stage 1: X-rays appear normal, but MRI shows microfractures in the subchondral bone.

• Stage 2: X-rays reveal a depression on the dorsal (top) surface of the second metatarsal head.

• Stage 3: The collapse of the second metatarsal head progresses, with only the plantar (bottom) surface remaining intact.

• Stage 4: Complete collapse of the second metatarsal head is visible on X-rays, along with joint space narrowing.

• Stage 5: Advanced joint degeneration with cartilage fragments visible inside the joint.(If you suspect you may have big toe arthritis, you can click the related link to learn more.)

Can Freiberg Disease Heal on Its Own?

Treatment for Freiberg disease usually begins with non-surgical (conservative) methods. This includes supportive footwear, orthopedic insoles, and anti-inflammatory medications. In more advanced cases, where symptoms persist or worsen, surgical options may be considered.

How Is Freiberg Disease Treated?

In the early stages of Freiberg disease:

• Activities are limited and adjusted.

• Pain is managed with analgesics.

• A walking boot or cast is often used for about 6 weeks.

• After immobilization, custom orthotics are prescribed for long-term support.

Surgical Treatment of Freiberg Disease

Surgery is considered when non-surgical treatments fail to relieve pain or when toe deformity becomes prominent. Various surgical procedures are available depending on the stage of the disease:

• Joint debridement and removal of loose bodies from the 2nd metatarsophalangeal (MP) joint.

• Dorsal closing wedge osteotomy, a bone-cutting procedure on the second metatarsal.

• DuVries Procedure (typically used in stage 4 or 5): The severely damaged metatarsal head is removed along with some bone, and the resulting gap is filled using soft tissue transferred from nearby areas.

Is Freiberg Disease Surgery Risky?

Surgical intervention is reserved for advanced cases that do not respond to conservative treatments. The aim is to restore joint alignment and reduce pain. Although the success rate is high, as with any surgery, there are risks involved. Choosing the right surgeon and treatment plan is critical for optimal outcomes.

Recovery After Freiberg Disease Surgery

Postoperative recovery is a crucial phase. The patient is usually advised to avoid weight-bearing activities for a period. Physical therapy and regular follow-ups are recommended to support healing and restore function.

(To learn more about stress fractures in the foot, click the related link.)

Patient Testimonials After Freiberg Disease Surgery

Most of our patients report significant pain relief and a return to daily activities after surgery:

• “The relief I felt in my foot after surgery by Dr. Utku Erdem Özer was incredible. After suffering for so long, I can finally walk normally again. I’m truly grateful for the professionalism and care shown by Dr. Özer and his team.”

• “Dr. Utku Erdem Özer did an excellent job with my Freiberg disease surgery. He explained every detail before and after the procedure and made sure I was comfortable throughout the process. I feel much better now and have returned to an active lifestyle.”

  
  

Conclusion

Freiberg disease is a condition that typically affects adolescent females and involves reduced blood supply to the second metatarsal head in the foot. It commonly presents with pain, swelling, and joint stiffness.

Treatment often starts with non-surgical methods, such as supportive footwear, orthotics, and anti-inflammatory medication. In advanced stages, if pain persists and toe deformity occurs, surgical treatment may be necessary.

Surgical intervention is typically effective for relieving pain and correcting deformities, although—as with any operation—certain risks are involved. Most patients experience positive outcomes and improved quality of life following surgery.

Early diagnosis and appropriate treatment are key to successful recovery. We encourage you to get in touch with us to discuss your symptoms and learn more about your treatment options.

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