Pain under your second toe? It could be Freiberg’s Infraction

23 Apr

Frieberg’s Infraction (aka Frieberg’s Disease) is a disorder of the metatarsal bones in the foot (the long bones between your ankle and your toes). Pain is felt in the ball of the foot due to damage to the front of the metatarsal bone. Frieberg’s Infraction can occur in any metatarsal but most frequently, the second or third metatarsals.

Freiberg's Infraction

Freiberg’s Infraction usually appears in adolescent female athletes whose 2nd toe is longer than their big toe

**Note – the word “infraction” in this case, is a combination of Infarction (obstruction of the blood supply, leading to the death of tissue) and fracture (as the infarction is usually caused by microfractures).

Typically, Freiberg’s Infraction is seen in adolescents 13-18 years of age who are very active. Females are 5 times more likely than males to have this condition.  The patient usually has a longer second metatarsal or toe than the others and may have had previous stress fractures of this bone.

When this deformity is present, the longer metatarsal takes more of the weight when walking, running, and jumping. This repeated stress on the bone and joint can result in microfractures or joint damage, interrupting blood supply to the bone and cartilage. If undiagnosed, and the lack of blood flow continues, bone cells may die (avascular necrosis). This is called Freiberg’s Infraction.

When bone tissue dies, it undergoes changes such as flattening of the joint surface, and moving the joint may cause pain and swelling. As the damage increases, the joint between the affected metatarsal and the toe degenerates. The damaged bone may fracture, leading to small, loose bone fragments in the joint area causing further pain.

Causes of Freiberg’s Infraction

  • Growth spurts during adolescence
  • Heredity
  • Trauma
  • Infection

Symptoms of Freiberg’s Infraction

  • Usually occurs only in those whose second toe (2nd metatarsal) is longer than their big toe (1st metatarsal).
  • A dull pain in the ball of the foot behind the second toe. Pain gets worse when walking, especially in high heels.
  • Ball of the foot may become swollen, callus may appear, and skin become red
  • The joint in the toe may be stiff and painful
  • The joint may make a cracking or grinding sound when moved

In many cases, no symptoms are present, and Freiberg’s is discovered during a routine foot exam

Treatment for Freiberg’s Infraction

Some patients have no symptoms (asymptomatic) and the Freiberg’s Infraction resolves without treatment. But it’s advisable to seek treatment from a podiatrist as soon as symptoms appear, because if left untreated, tremendous damage can occur to the metatarsal, requiring surgery.

Early Treatment

  • Rest
  • Ice
  • No weight bearing activities for 4-6 weeks
  • Over the counter medicine like advil or aleve to control pain and inflammation
  • Custom orthotics molded to relieve pressure on the ball of the foot
  • Wear padded and supportive athletic shoes – no high heels. Use over the counter padding in shoes if necessary
  • If swelling and pain are advanced, a cast may be applied to the foot to immobilize it for 4-6 weeks

Advanced Treatment

If the Freiberg’s Infraction fails to resolve with conservative treatments, more aggressive treatment may be necessary. This may include:

  • Removing the damaged bone
  • Bone grafting to create a new bone
  • Shortening the length of the affected metatarsal
  • Reconstructing the joint to eliminate pain and stiffness
  • Joint removal and implant

If you have pain in the ball of your foot, please make an appointment with the podiatrists at PA Foot and Ankle Associates to determine if your pain is caused by Freiberg’s Infraction or another condition.

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