Freiberg's Disease

What is wrong with my foot?

This is an uncommon disease where the blood supply is compromised to the metatarsal head, most commonly seen in teenage girls.

Why has this happened?

It occurs during the growth spurt at puberty, most commonly it is found in young females with a male:female ratio of 1:5. It is also more common in patients whose first metatarsal is shorter than the second metatarsal, which increases the weight on the second metatarsal head. The initial injury, as described by Freiberg, was thought to be repetitive stress with microfractures at the growth plate. The microfractures deprive the growth plate of adequate circulation, and there is avascular necrosis of the metatarsal head.

Although the second metatarsal is most often affected, the third metatarsal may also be involved; involvement of the fourth or fifth is rare.

Symptoms include:

  • Pain in the forefoot, usually localised to the head of the second metatarsal.
  • Usually this is associated with physical activity.
  • Wearing high-heeled shoes makes it worse.
  • There may also be localised swelling and stiffness in the metatarsophalangeal joint.
  • A limp may be visible.

Do I have to have an operation?

Pads, splints, foot orthoses and special shoes can be used to provide comfort but will not cure the arthritis. Supportive footwear with a metatarsal bar or pad placed beneath the involved bone can help. Reduce weight-bearing activities for four to six weeks. If symptoms are severe, a fracture boot until the symptoms subside - usually within 3-4 weeks is considered. Pain medication may also be used and cortisone injections. If the arthritic joint is still uncomfortable despite these measures then an operation will usually be recommended.

This is rarely used, but the most usual indication is failure of conservative treatment. Options include:

  • Debridement
  • Bone grafting
  • Osteotomy (Controlled fracture of the bone)
  • Arthroplasty
  • Osteochondral transplantation

How successful is the operation?

90-95% of people are very satisfied with the results of the operation, as they no longer have pain from the arthritic joint. They are then able to wear normal shoes again, but the height of the shoe heel should not be greater than 1 inch.

Are there any risks associated with the operation?

As with all operations there are risks associated with the anaesthetic. Occasionally some patients may have complications such as infection or prolonged swelling.  There may be some residual pain in the forefoot. Occasionally the joint may not fuse necessitating a further operation.

What will happen after the operation?

The operation is usually day case but you may need to stay overnight in hospital. The Podiatric surgeon will discuss this with you. You will be given special shoes to wear over your bandages and you must wear these whenever you want to walk. The shoes must be worn for 4-6 weeks. You do not need to use crutches. It takes the foot a good 6 months to fully settle down after surgery.

What happens when I leave hospital?

For the first 48 hours you will rest in bed with your legs elevated and should take the painkillers prescribed for you. You will be asked to do some foot exercises during this time. The bandages will be left on for 2-6 weeks. You will be given an Outpatients appointment to return to have the bandages removed. You will be able to return to work from 2-8 weeks after the operation, depending on whether you need to stand or walk around a lot for your job. You will not be able to drive until you come out of the post-operative shoe

Orthopaedic and Fracture clinic appointment  to have the bandages removed. You will be able to return to work from 2-6 weeks after the operation, depending on whether you need to stand or walk around a lot for your job. You will not be able to drive until you come out of the post-operative shoe.