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. 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.

Slow Toe Deterioration

The ball of the foot is an important weight-bearing structure that you use for normal movement. It’s the point where the ends of your metatarsal bones, called the metatarsal heads, meet your toes. Those joints hold a significant amount of pressure when you walk and push off the ground. Under the wrong conditions, this repetitive pressure can lead to injury and pain in the second toe. Freiberg’s disease is one of those “wrong conditions.” It’s a rare injury that results in the slow breakdown of the second metatarsal head.

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, 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.

What You Feel

This causes a significant amount of discomfort in the ball of the foot that only gets worse with time. Usually the discomfort is clearly under the affected digit and feels worse with physical activity. Shoes that put pressure on the forefoot, like high heels, may aggravate it. The toe may become stiff and difficult to move. Sometimes the area swells as well. If the pain is significant, you may end up limping. On rare occasions, Freiburg’s disease can actually develop under the third or fourth toes, instead of just the second.

What Can Be Done

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 and our staff at Next Step Foot & Ankle Clinic will use 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. Padding the area under the digit can reduce some of the pressure on the bone. You might need to make some changes to your shoes and use orthotics to better support your forefoot. You’ll need to cut down on your physical activities for a time, too, to avoid straining the second toe. For more severe pain, your foot will need to be immobilized and weight offloaded to allow the bone tissue to recover. We might recommend pain medication or direct injections as well. If your foot does not respond to these treatments, you’ll need surgery to correct the issue and save the toe from worse damage.

Freiberg’s disease is a rare but serious cause of forefoot pain. It needs to be managed sooner than later to prevent complications that could restrict your mobility and independence. If you’re concerned about progressively worse pain in the second toe, let Dr. Darren Silvester at Next Step Foot & Ankle Clinic know. He can help diagnose even the more uncommon foot conditions and diseases. Call (830) 569-3338 to make an appointment at our San Antonio, TX, office

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