Freiberg’s Disease – Understanding is the key to success!

People can really worry when they hear about Freiberg’s Disease! The name itself can sound scary, but don’t worry. Like anything, the more you understand something, the less there is to worry about.

Frieberg’s disease can have a real impact on your life and stop you from doing what you want to do and it doesn’t have to be that way forever. There is so much that can be done to move on from the pain and get you back to doing the things you want to do again!

Learn more about Freiberg’s Disease and as well as treatment options to get over Freiberg’s Disease for good.

What is Freiberg’s Disease?
Freiberg’s disease is a condition of the foot where a change in bone health, including loss of blood flow and eventually fractures occurs in the ends of the bone/s of the forefoot.

What are the symptoms of Freiberg’s Disease?
People that experience Freiberg’s disease will experience a feeling of soreness at the second and third metatarsal heads and the surrounding tissue (this area is commonly referred to as the ‘ball of the foot’). The feeling of pain will often present gradually over days or weeks and intensify as the problem becomes established. During the initial stages of onset, pain will become more noticeable after periods of rest (for example; with the first few steps after rising from the couch) and will continue to intensify with ongoing movement or activity. 

As it becomes more established, people with Freiberg’s disease will limp as a means to prevent forces of the body travelling through the fracture site and therefore pain as they walk.

Freiberg’s Disease typically will only affect one foot at a time, however in some cases can affect both feet at the same time.

How is Freiberg’s Disease diagnosed?

Established cases of Freiberg’s Disease can be diagnosed with typical medical imaging such as X ray, MRI and other scanning techniques like bone scans.

In less established cases, it is possible that Freiberg’s Disease can go unrecognised with a simple X ray.

While imaging can be helpful, a good therapist who has experience working with Freiberg’s Disease can assess and diagnose Freiberg’s Disease and begin treatment during the first session of treatment, without the need for further imaging.

What causes Freiberg’s Disease?
Freiberg’s Disease is caused by a lack of blood flow in the area of bone affected leading to a reduction of bony strength, and eventually fracture.

The restriction of blood flow is influenced by weight bearing pressure/ repetitive physical stress and for this reason, people that experience Freiberg’s Disease will present with:

– higher activity levels (such as playing sports like basketball or netball),
– physically demanding occupations (such as farm work or long periods of standing in retail)
– bony prominences of the bones of the foot (bony prominence  leads to increased pressures)
– influencing foot posture (shape of the foot leads to increased pressures)
– influencing gait pattern (walking pattern leads to increased pressures)

Who gets Freiberg’s Disease?
Frieberg’s Disease often presents in adolescent athletes and affects more young females than males.

What are the treatment options for Freiberg’s Disease?
Short term management of Freiberg’s Diseases are usually targeted at reducing the pain and improving function.

This can include:

  • Reducing the amount of provocative activities such as walking, running, playing sport etc. 
  • Wearing lace up shoes to refrain from excessive movement within the foot and ankle, leading to pain
  • Using ice packs to reduce the swelling and pain
  • Taking anti-inflammatory medication to reduce the swelling and pain
  • In some cases, using crutches or protecting the area with a moon boot can be useful

Long Term Management

It is very common that long term management is offered as wearing a protective boot (moon boot) for 6+ weeks without consideration of addressing the underlying cause of the problem, or helping a person return to activity.

For this reason, some people can experience recurrence of a Freiberg’s Disease following healing of the fracture and once normal loading of the foot resumes (once the boot has been removed). 

Successful long term management of Freiberg’s Disease within a foot must begin with a thorough assessment and understanding of the influencing factors that have caused the problem. 

A successful long term management plan will address the underlying cause of the problem and may include: 

  • Load/ activity management (this may include use of a boot or crutches)
  • Footwear advice/ consideration 
  • Orthotic therapy to influence biomechanics and gait (the particular way the foot is being loaded)
  • Strength and conditioning exercises (to make the body stronger, influence movement and gait and prevent recurrence of injury)


Helpful Links and Resources
Please feel welcome to book an appointment here, or call us on (03) 52981147.
Understand and learn more with the following resources:
How Do Orthotics Work?
Foot bursitis. A sometimes poorly understood and often mis-treated condition.


Written by:

Daniel Monteleone

Podiatrist, Strength & Conditioning Coach

Foot & Ankle Pain
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