Freiberg's Infraction – A Rare but Treatable Foot Bone Condition
Freiberg's infraction is a rare but treatable condition causing pain beneath the ball of your foot. Learn about symptoms, diagnosis, and both conservative and surgical treatment options at Central Florida Foot & Ankle Institute.
By Dr. Carli Hoover, DPM
Freiberg's Infraction – A Rare but Treatable Foot Bone Condition
If you've noticed pain under the ball of your foot, particularly around your second metatarsal head, you might be dealing with Freiberg's infraction. This condition, while uncommon, can significantly impact your ability to walk and participate in activities you love. At Central Florida Foot & Ankle Institute, we understand the challenges that come with rare foot disorders, and we're here to help you find relief.
What Is Freiberg's Infraction?
Freiberg's infraction is a condition where the bone in the ball of your foot—typically the second metatarsal head—begins to die due to loss of blood supply. Also known as Freiberg's disease or metatarsal head necrosis, this disorder most commonly affects adolescents and young adults, particularly those who are active in sports. The condition can range from mild to severe, depending on how much of the bone is affected.
Unlike many foot conditions that develop gradually, Freiberg's infraction usually begins with an impact or repetitive stress to the area. The pressure disrupts blood flow to the bone, causing tissue death and bone collapse over time.
What Causes Freiberg's Infraction?
Biomechanical Factors
Your foot's structure plays a significant role in whether you'll develop Freiberg's infraction. If you have a long second metatarsal bone or a relatively short first metatarsal, you may place more pressure on the second metatarsal head during walking or running. This abnormal weight distribution increases stress on the bone's blood supply.
Trauma or Repetitive Stress
A single injury or repeated microtrauma can trigger the condition. Many patients report a history of stomping, jumping, or kicking that preceded their symptoms. Athletes—especially those in basketball, soccer, volleyball, or track—face higher risk due to the intense repetitive impact their feet endure.
Age and Activity Level
Freiberg's infraction typically occurs during the teenage years and early twenties, a time when growth plates are active and the skeletal system is still developing. High-level athletic participation during these critical years significantly increases your risk.
Recognizing the Symptoms
Early Signs
You may first notice mild pain or tenderness beneath the second or third metatarsal head. This discomfort might appear after activity and initially resolve with rest. Many people dismiss these early symptoms as a simple bruise or minor strain.
Progressive Symptoms
As the condition advances, pain typically becomes more persistent. You might experience:
- Swelling across the ball of your foot
- Stiffness when walking or pushing off your toes
- Difficulty with certain sports or activities
- Pain that intensifies with high-impact exercise
- Limping to avoid putting weight on the affected area
If left untreated, Freiberg's infraction can lead to chronic pain and permanent damage to the joint.
How We Diagnose Freiberg's Infraction
During your visit to Central Florida Foot & Ankle Institute, we begin with a detailed history and physical examination. Our podiatrists will ask about your symptoms, activity level, and any recent injuries. We'll palpate the affected area and observe your walking pattern to identify irregularities.
Imaging Studies
X-rays are the primary diagnostic tool and can reveal bone collapse, flattening, or fragmentation. Early in the disease, plain X-rays may appear normal, so we might recommend an MRI to detect early bone changes. Magnetic resonance imaging is particularly valuable because it shows bone marrow edema and blood supply disruption before significant structural damage occurs.
A CT scan provides detailed 3D images of the bone and helps us assess the extent of involvement, particularly useful when planning surgical intervention if necessary.
Treatment Options for Relief
Conservative Care (Non-Surgical)
Most cases of Freiberg's infraction respond well to conservative treatment, especially when caught early. Our approach focuses on reducing stress to the affected area and allowing the bone to heal.
Activity Modification: We'll work with you to identify activities that trigger pain and develop a plan to reduce impact. This might mean temporarily switching from running to swimming or cycling.
Custom Orthotics: A specially designed orthotic insert or metatarsal pad redistributes pressure away from the affected metatarsal head, reducing stress and promoting healing.
Immobilization: A walking boot or stiff-soled shoe can limit motion in the forefoot, protecting the bone while it heals.
Physical Therapy: Gentle stretching and strengthening exercises improve foot flexibility and muscle support, taking pressure off the affected bone.
Rest and Ice: Regular icing reduces inflammation, while adequate rest allows healing to progress.
Surgical Intervention
If conservative treatment doesn't resolve your symptoms after 6-12 months, or if significant bone damage is already present, surgery may be necessary.
Surgical Options Include:
- Joint-sparing procedures: These preserve the joint while improving blood flow to the damaged bone
- Realignment surgery: Redistributing forces across the forefoot to reduce pressure on the affected metatarsal
- Joint replacement or fusion: In advanced cases where significant arthritis has developed The AAOS foot-and-ankle arthritis page walks through those end-stage choices: when cartilage is gone and the joint stays painful, fusion or, less often, joint replacement is how surgeons stop bone-on-bone motion.
Our surgeons at CFFAI have extensive experience with these procedures and will discuss which option is best for your specific situation.
When to See a Podiatrist
If you experience persistent pain under the ball of your foot—especially if you're a young athlete—don't wait. Early intervention offers the best chance for a complete recovery without long-term complications.
Visit Central Florida Foot & Ankle Institute if you notice:
Pain that doesn't improve with rest and over-the-counter pain medication Swelling or stiffness that's affecting your activities Pain that started after an injury or period of increased activity Difficulty walking or putting pressure on certain parts of your foot
Your Path to Recovery Starts Here
Freiberg's infraction may be rare, but at Central Florida Foot & Ankle Institute, we have the expertise to diagnose and treat it effectively. Whether you need conservative care or surgical intervention, our team is committed to getting you back on your feet.
Don't let foot pain limit your life. Call (407) 307-0006 or book your appointment at https://floridafai.intakeq.com/booking today. With locations in Lake Mary (Waymont and MedPlex) and Downtown Orlando / SODO, we're conveniently located to serve you. People also drive in from Sanford, Altamonte, and Longwood — we do not have offices in those towns.