Freiberg's disease — also called Freiberg's infarction or Freiberg's osteochondrosis — is a condition in which the blood supply to a metatarsal head is disrupted, causing localised bone death (avascular necrosis) at the joint surface. It most commonly affects the second metatarsal head, and less often the third, at the point where the toe joins the ball of the foot.
It typically develops during adolescence, while the growth plate and blood supply to the metatarsal head are still maturing, and is significantly more common in girls than boys. Repetitive impact through the forefoot — from running, jumping or dance — is thought to be a key trigger, compressing the vulnerable blood supply to the bone at a stage when it is least able to withstand it.
Adolescence
Most cases present between the ages of 11 and 17, during a period when the metatarsal head's blood supply is developmentally more vulnerable to disruption.
Female Sex
Freiberg's disease is substantially more common in girls and young women than in boys, for reasons not yet fully understood.
Repetitive Forefoot Loading
High-impact sport, running, jumping and dance repeatedly compress the metatarsal head, a likely contributing factor to the vascular disruption.
A Long Second Metatarsal
Where the second metatarsal is longer than the first, it bears a disproportionate share of forefoot load during push-off, increasing stress at the joint.
Tight or Unsupportive Footwear
Narrow, high-heeled or poorly cushioned footwear increases pressure through the forefoot and metatarsal heads.
Gradual-onset pain localised to the second (or third) metatarsal head, at the ball of the foot
Pain that worsens with weight-bearing, running, jumping or standing on tiptoe
Swelling and tenderness directly over the affected joint
Stiffness and reduced range of motion at the affected toe joint
A limp or altered gait to offload the painful forefoot
In longer-standing cases, a sensation of grinding or catching in the joint
Diagnosis begins with a clinical examination — palpating the metatarsal heads, assessing joint range of motion, and testing for pain with axial loading of the affected toe. X-ray can support the diagnosis but may appear normal in the earliest stages, before bony changes become visible. Where clinical suspicion is high but X-ray is inconclusive, MRI is the most sensitive investigation and can detect the earliest stages of avascular change before they show up on X-ray.
Freiberg's disease is staged by the degree of flattening, fragmentation or collapse of the metatarsal head visible on imaging — this staging helps guide whether conservative management or surgical referral is the more appropriate path.
Most cases, particularly when caught early, respond well to conservative, activity-modifying treatment aimed at reducing load through the affected joint while the bone heals. More advanced or long-standing cases with significant joint damage may need referral for surgical opinion.
If your child (or you) has persistent forefoot pain at the ball of the foot that isn't settling with rest, especially in an active adolescent, an assessment is worth booking sooner rather than later. Freiberg's disease diagnosed and managed early — before significant joint changes develop — generally has a good outcome with conservative treatment alone.
Will this get better on its own?
Many cases improve significantly with activity modification and offloading, particularly when caught early. However, ongoing high-impact activity without treatment risks progressive joint damage, so an assessment is recommended rather than waiting it out.
Does my child need to stop sport completely?
Not necessarily, but high-impact activity usually needs to be reduced or modified while the joint settles. We aim to keep your child moving in ways that don't aggravate the joint, with a structured return to full activity once symptoms allow.
Will this cause long-term problems?
With early diagnosis and appropriate offloading, most cases recover well without lasting joint damage. More advanced cases with significant collapse of the metatarsal head can lead to chronic stiffness or early degenerative changes in that joint, which is why early assessment matters.
Is it the same as a stress fracture?
No — a metatarsal stress fracture is a crack in the bone from repetitive load, while Freiberg's disease is a disruption to the blood supply of the metatarsal head itself. They can present similarly with forefoot pain, so imaging is often used to confirm which is present.
Is treatment covered by health insurance?
Yes — podiatry consultations are typically covered by most major insurers. We work with Bupa, Aviva, WPA and others. See our
insurance page for full details.
Ready to book your assessment?
We'll diagnose your forefoot pain accurately and build the right offloading plan while your child stays as active as possible.
