Freiberg’s disease — forefoot bone pain in teenagers.
Pain at the ball of the foot in an active teenager, particularly during running, jumping or pushing off. Freiberg’s disease is an avascular necrosis of the second (sometimes third) metatarsal head — treatable, but worth catching early.
What Freiberg’s disease is.
Freiberg’s disease is an avascular necrosis affecting the head of the second metatarsal (less commonly the third). The bone temporarily loses its blood supply during the growth years — usually 13-18 years — leading to bone-cell death, collapse of the metatarsal head, and eventual repair with some residual deformity in most cases.
Most commonly seen in adolescent girls, particularly those who are tall, active in sport, and have a long second toe (a structural pattern called Morton’s foot). The bone changes happen silently first, then symptoms develop — pain at the ball of the foot, particularly with weight-bearing and push-off activity, sometimes a feeling that there’s a stone in the shoe.
Catching it early matters. Late-stage Freiberg’s with significant joint destruction can require surgical intervention. Early-stage Freiberg’s can be managed conservatively with offloading, orthotic support, activity modification and time.
Six management strategies for Freiberg’s.
Conservative treatment is the first line for most cases, particularly when caught at the early stages.
Three steps from first visit to outcome.
