# Freiberg's disease > Freiberg's disease is a rare condition in which the blood supply to the end of a toe bone is disrupted, causing pain in the ball of the foot, most often behind the second toe. It mostly affects teenage girls and young women. Most people start with taking pressure off the area; surgery is rarely needed. Guide in [Toes and forefoot](https://footanklelowerlimb.com.au/learn/topics/toes-and-forefoot), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/freibergs-disease Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **A rare bone problem in the forefoot:** the blood supply to the end of a toe bone is disrupted, usually behind the second or third toe. - **It mostly affects teenage girls and young women,** though it can happen at any age. - **Early care is simple:** taking pressure off the sore area with activity changes and comfortable, well-padded shoes. - **Surgery is rarely needed** and is usually considered only after about 6 months of other care. - **Other conditions can feel similar,** so pain in the ball of the foot is worth getting checked. ## What is Freiberg's disease, and how common is it? Freiberg's disease (also called Freiberg's infraction) is a rare condition [1]. The blood supply to the end of one of the long bones behind your toes (a metatarsal) is disrupted, so that area of bone dies and crumbles [2]. The clinical name is osteonecrosis (bone death) of the metatarsal head. It most often affects the bone behind the second toe, then the third [3]. It mostly affects teenage girls and young women, but it can happen at any age [4]. Over time the bone end can flatten and collapse, and the joint at the base of the toe can develop arthritis later [4]. ## What causes Freiberg's disease, and who gets it? No one knows the exact cause [2]. The leading idea is that repeated stress on the forefoot disrupts the blood supply to the end of the bone [5]. Blood vessel problems, genes and the way the foot works may also play a part [3]. It's seen most in teenage girls who play sport, although it can occur across a wide age range [6]. Because the cause isn't fully understood, you haven't done anything wrong, and there's no known way to prevent it [3]. It can help to tell your podiatrist about activities that load the ball of your foot, and any family history. ## What does it feel like, and how is it diagnosed? The usual sign is pain near the ball of the foot, often behind the second toe, that's worse with activity [7]. There may also be swelling, tenderness, clicking or grating, and less movement in the toe joint [7]. Many other problems can cause pain in the same place, including Morton's neuroma (a pinched nerve), a stress fracture (a small crack in the bone) and plantar plate injury (damage to the ligament under the toe joint) [8]. Their features overlap, so it isn't something to work out from symptoms alone [9]. A podiatrist or doctor will ask how the pain began and what makes it worse, then examine your forefoot [8]. The diagnosis is made from this and confirmed with an X-ray [3]. Early on, the X-ray can look normal, so a bone scan or MRI may be used. Later X-rays show a flattened, broken-up bone end [3]. ## What can I do first, and what will a podiatrist suggest? Treatment without surgery is the first step [4]. The aim is to take pressure off the sore bone end [3]. You can start yourself: cut back on activities that flare the pain, wear comfortable, well-padded shoes with plenty of room for the toes, and avoid high heels [2]. A podiatrist or doctor can add shoe inserts (orthoses) or metatarsal pads, and sometimes a short time in a walking boot, cast or stiff-soled shoe [7][5]. A pharmacist or doctor can advise on pain relief. Early disease often settles with this kind of care, and may even settle by itself [3]. The research on treatments for Freiberg's disease is limited, and no one option has been shown to be best [10]. It's worth reviewing progress regularly; if you're not improving, your podiatrist can plan the next step. > [!tip] Try this > For the next couple of weeks, wear your most comfortable, well-padded shoes with room for your toes, and swap activity that sets off the pain for something gentler. ## What helps if that isn't enough? Surgery is considered if care without surgery hasn't worked after about 6 months [4]. It's rarely needed [2]. Which operation suits depends on your age, activity level and the condition of the joint, so it's a shared decision with an orthopaedic surgeon [4]. Your GP or podiatrist can refer you. Operations that keep the joint tend to give better results than those that remove or destroy part of it [10]. Every type of operation carries a risk of a stiff or "floating" toe (one that no longer rests on the ground) and of pain moving to a neighbouring toe bone [11]. ## How long does recovery take, and can it come back? The outlook is generally good, but no set recovery time can be promised. Early disease often settles with care that doesn't involve surgery [6]. Treating it early seems to matter: in children who had surgery, more advanced disease was linked to poorer results [12]. Many people who have surgery report pain relief and a return to full activity [10]. It isn't clear yet how often Freiberg's disease returns, what prevents it, or when it's safe to return to sport. Check with your podiatrist before going back to full sport. If pain returns or gets worse, have it reassessed rather than waiting. ## When to see a podiatrist See a podiatrist if toe pain hasn't improved after 2 weeks of home care [13], or if the diagnosis is unclear or the pain is getting worse [8]. See your GP if you have diabetes and foot pain [13]. See your GP soon if you have severe pain that doesn't ease, pain at night that stops you sleeping, a fever or weight loss with no clear reason, or swelling lasting more than 2 weeks with no clear cause [14][15]. See your GP or a podiatrist the same day if: - your foot becomes red, hot, swollen or has pus, which can mean an infection, including inside the joint [13]; - your foot suddenly changes shape [15]; - you can't put weight on your foot after an injury [8]; - your symptoms quickly get worse after foot surgery (let your surgeon know too) [14]; - you have diabetes and a wound, sore, blister or colour change on your foot. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. ## Common questions ### Is Freiberg's disease the same as Freiberg's infraction? Yes. Freiberg's disease, Freiberg's infraction and osteochondrosis of the metatarsal head are different names for the same condition. Some sources use "Freiberg's disease" only for the second toe bone, while others include the third as well. If you see a different name on a report, ask your podiatrist to explain it. ### Will Freiberg's disease go away on its own? Early disease can settle, often with simple care that takes pressure off the area, and sometimes by itself. That isn't guaranteed, and it's hard to say how long it will take. If pain in the ball of your foot isn't improving, it's worth having it checked rather than waiting it out. ### Can I keep playing sport with Freiberg's disease? It usually helps to cut back on the activities that flare the pain while the area settles, and to choose gentler activity that doesn't hurt. It isn't clear yet when it's safe to return to full sport, so check with your podiatrist before you do. ### Why are teenage girls more affected? Freiberg's disease is seen most often in teenage girls and young women, especially those who play sport, but the reasons for this aren't known. It's a pattern that has been observed, not proof of what causes the condition, and boys, men and older adults can be affected too. ## Further reading - [Freiberg's disease on Clindice](https://clindice.com/freibergs-disease) - [Foot pain: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003183.htm), MedlinePlus - [Pain in the ball of the foot](https://www.nhs.uk/symptoms/foot-pain/pain-in-the-ball-of-the-foot/), NHS - [Freiberg’s condition](https://www.royalberkshire.nhs.uk/media/h20pukxs/freibergs-condition_apr25.pdf), NHS - [Metatarsalgia – forefoot pain](https://www.kentcht.nhs.uk/leaflet/metatarsalgia-forefoot-pain/), NHS ## Sources 1. Freiberg's disease: variation of surgeries, outcomes, and first population-based incidence. · Rehm A, Seah M, Chase HE et al. · Journal of Pediatric Orthopedics · 2025. https://doi.org/10.1097/bpb.0000000000001243 2. Freiberg’s condition · NHS. https://www.royalberkshire.nhs.uk/media/h20pukxs/freibergs-condition_apr25.pdf 3. Freiberg's infraction: diagnosis and treatment. · Talusan PG, Diaz-Collado PJ, Reach JS · Foot & Ankle Specialist · 2014. https://doi.org/10.1177/1938640013510314 4. Evidence-Based Treatment Algorithm for Freiberg Disease. · Yoshimura I, Takao M, Wagner E et al. · Cartilage · 2024. https://doi.org/10.1177/19476035231205676 5. Anatomy, Bony Pelvis and Lower Limb: Metatarsal Bones · Lezak B, La Rose J, Massel DH · NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/sites/books/NBK549872/ 6. Freiberg Disease and Avascular Necrosis of the Metatarsal Heads. · Wax A, Leland R · Foot and Ankle Clinics · 2019. https://doi.org/10.1016/j.fcl.2018.11.003 7. Late Stage Freiberg Infraction in a Division I Collegiate Tennis Player. · Faircloth J, Mitchell JJ, Edwards DS · Journal of Orthopaedic Case Reports · 2015. https://doi.org/10.13107/jocr.2250-0685.295 8. Forefoot pathologies | Right Decisions · NHS. https://www.rightdecisions.scot.nhs.uk/refhelp-nhs-ayrshire-and-arran/orthopaedicsmsk/foot-and-ankle/forefoot-pathologies/ 9. Differential Diagnosis of Metatarsalgia. · Afonso PD, Britto SV, Spritzer CE et al. · Seminars in Musculoskeletal Radiology · 2023. https://doi.org/10.1055/s-0043-1764388 10. Surgical Management of Freiberg's Infraction: A Systematic Review. · Schade VL · Foot & Ankle Specialist · 2015. https://doi.org/10.1177/1938640015585966 11. Treatment of Freiberg Disease. · Seybold JD, Zide JR · Foot and Ankle Clinics · 2018. https://doi.org/10.1016/j.fcl.2017.09.011 12. Long-term Follow-up of Dorsal Wedge Osteotomy for Pediatric Freiberg Disease. · Pereira BS, Frada T, Freitas D et al. · Foot & Ankle International · 2016. https://doi.org/10.1177/1071100715598602 13. Foot pain - Leeds Community Healthcare · NHS. https://leedscommunityhealthcare.nhs.uk/our-services-a-z/podiatry/foot-pain/ 14. Foot and Ankle Pain Pathway (Age 16+) · NHS. https://www.dgft.nhs.uk/wp-content/uploads/2026/10/Foot-and-Ankle-Pain-v1.8.pdf 15. Foot and Heel Problems - South & West · South & West. https://southwest.devonformularyguidance.nhs.uk/referral-guidance/western-locality/musculoskeletal/foot-and-heel-problems --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.