Freiberg’s disease- AVN of the 2nd Metatarsal

Freiberg’s disease is a condition affecting the foot which results in infarction and fracture of the metatarsal heads. This condition affects females more than men (4:1 ratio). The onset is insidious and patients present with persistent pain to the ball of their foot. The most commonly affected bone is the 2nd metatarsal but other lesser metatarsals can also be affected.

Patients who have a long 2nd metatarsal are predisposed to develop this condition. Having a long 2nd metatarsal results in stress overload of the met head. This coupled with repetitive and chronic microtrauma results in disruption of the blood supply to the metatarsal head, causing necrosis and eventual collapse.


Patients complain of pain and swelling on the ball of the foot which is worse with ambulation. Rest and ICE are relieving factors. Diagnosis is made radiographically by taking x-rays in the office. Often the X-rays are inconclusive and MRI is ordered to confirm the diagnosis.

Treatment depends on the stage of the disease. Early on, if identified, patients are treated with RICE, immobilization in a CAM walker for 4 weeks with eventual transition to stiff sole shoes with custom orthotics. Surgical intervention is reserved for advanced disease and when conservative measures fail. This includes resection of the involved metatarsal head, interpositional arthroplasties, and in some cases artificial joint placement.


Please see our expert doctors if you suffer from this condition to see what is your option to address this condition