Freidberg's disease

AKA freidberg's Infarction

- rare second toe breakdown -

FREIDBERG'S DISEASE Frequently Asked Questions

Although it’s rare, pain in the second toe can be caused by just that: an uncommon condition called Freiberg’s disease that allows the end of the metatarsal bone to wear down under stress.

Imagine you’re drawing with chalk on rough pavement. As you draw, the stick of chalk in your hand slowly wears down under the pressure and grinding.

Enough pressure over a period of time can wear down pretty much anything, including mountains, concrete, and the structures in your feet.

Freiberg’s disease is an infliction or pain that occurs at the end of the 2nd metatarsal (and to a lesser degree the 3rd metatarsal).

The condition isn’t well understood, but it seems to be a combination of repetitive stress to the metatarsal head, loss of blood flow to that bone; This is also known in medicine as an infarction. It literally means death of tissue from lack of blood supply. Thus, resulting in weakening of the bone and subsequent collapse, and even a genetic tendency for it.

In some cases, a traumatic injury may cause the initial damage that then gets worse with time.

Other times, a portion of the end of the bone may get cut off from the vital oxygen and nutrients it needs, weakening it.

Constant or repetitive pressure from bad shoes, activities, and even natural biomechanics then damage the bone and cause the painful deterioration.

As the problem develops, the bone in the metatarsal head begins to break down and slowly flatten out.

Freiberg’s Disease AKA Freidburg’s infarction feels like:

  • arthritis.
  • It is fairly well localized to the joints affected.
  • Swelling is frequently seen.
  • The 2nd  (or 3rd) toe also  can eventually become quite stiff.
  • It hurts to walk.
  • Moving the toe up and down bothers the patient quite a bit.
  • It can also hurt on the bottom of the foot quite a bit.
  • It can feel fairly severe or just be a nuisance. 

Freiberg’s infarction is much more common in women (5 times more common in some reports).

It generally occurs at an early age. Most common ages are from adolescents to about 30. However, it can occur at any age. There have been reports of Freiberg’s infarction at any age.

Freidberg’s Disease found more common in women, may be due to the fact that women wear high-heeled shoes that put a lot of stress on these bones.

In a normal foot the 2nd metatarsal is frequently a little longer than its neighbors,  and by standing with the foot in a plantar flexed position (like in high heels) a foot is a lot of stress on the end of that bone.

Rare. It is highly unlikely that you will have this problem.

There are other things that affect the area around the second metatarsal and the second toe joint that are much more common.

They include plantar plate rupture, neuromas, metatarsalgia, muscle imbalance causing hammer toes and much more. 

Click here to learn more about foot & ankle conditions. 

There are 5 stages of the disease. They, simply put, just document the severity of the collapse of the metatarsal head.

The more advanced the disease, the more likely chronic pain will occur.

stages of freidburger's diease aka freidberg's infarction

What if I think I have Freidberg's Diease?

Most likely you do not.  But if you do, or if you are having pain in that area, please give us a call and let one of our specialists help you.

Don’t allow yourself or those you love suffer in pain & discomfort!

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xray image of how high heels affect the foot



This is unfortunately a progressive condition. Eventually it can lead to arthritis and chronic pain. The sooner you take care of it, however, the more that can be done to correct it.

Dr. Darren Silvester, Dr. Gregory Larsen and our staff at Next Step Foot & Ankle Clinic will use advanced in-office tests to diagnose the condition. Most likely we will need diagnostic images to rule out other causes, then we can begin treatment.



Like other ball of the foot issues that cause pain in the second toe, we try conservative treatments first.

The doctor may suggest treating freidberg's diesease aka. freidberg's infarction by advising you to:



Initially, I would like to get the patient off the foot. Rest is critically important in the early stages of the disease and can stop the process altogether sometimes.

Use of a cam walker, weight-bearing on the heel, the use of a knee scooter can all be very helpful in salvaging the bone before the disease progresses too far.



Medications can also be used. Nonsteroidal anti-inflammatory drugs, L-arginine,  low-dose anticoagulants might be a consideration.

Topical use of transdermal nitroglycerin for vasodilation would also be a consideration.

Freiberg’s Disease: Rare Second Toe Breakdown

minimially invasive

treatment & surgery

for freidberg's disease


treatment & surgery options

Dr. Silvester and Dr. Larsen specialize in many advanced minimally and non-invasive treatments, and if necessaryadvanced minimally invasive and traditional surgical techniques with patient proven success stories.

Some of those are used to treat your freidburg’s disease aka. freidberg’s infarction, such as:

One of the best things for Freiberg’s disease that we have found are custom made orthotics.

They can dramatically decrease the pressure on the bone, and control the biomechanics so the bone can heal.

Check at our page on our custom orthotics (Go4D FitStation by Hewlette Packard). We have the most advanced  system available in South Texas for these devices.

MLS Laser therapy helps to stimulate vascularity.

Click here to learn more about MLS Laser Therapy and how it can help relieve your foot pain.

Shockwave Therapy helps to stimulate vascularity.

Click here to learn more about Shockwave Therapy and how it can help relieve your foot pain.

The literature has been fairly extensive regarding surgical options for Freiberg’s disease. There is good evidence that surgery can decrease stress on the metatarsal head and preserve function.

Simple surgeries such as metatarsal osteotomies just to get pressure off the bone (by making it a little bit shorter ) have been shown to be very effective.

Cartilage replacement therapies have also been used.

The specific surgery depends on the stage of the disease.

Shortening of the bone with some drilling of the necrosed bone is a mainstay of surgery.

Removal of spurs, hypertrophied tissue and loose bodies as well are always done.  

Treat your second toe pain AT THE SOURCE!

How can I relieve pain in the ball of my foot?

to relieve pain

Many people suffer from aching, persistent pain the balls of their feet. Dr. Darren Silvester, podiatrist in Pleasanton, and San Antonio TX, provides information on the various treatment options available to relieve your pain and keep you walking comfortably.

Learn more on our website or request to schedule your appointment today!

Take the next step
to happy feet!

Click the links to request your appointment or learn more about what Next Step Foot & Ankle Clinic can do for you.

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