Trauma & Sports

Freiberg's Disease: Forefoot Pain in Adolescents

Name: Freiberg's Disease Adolescents Milan: Forefoot Pain, Diagnosis and Treatment
Creator: Dott. Daniele Priano
Published: 2026-01-15

Does your teenage daughter have forefoot pain when walking? Freiberg's disease is a metatarsal osteonecrosis typical of girls 12-18. Milan.

Medically reviewed: March 2026·Dott. Daniele Priano

Quick Answers

Does Freiberg's disease heal on its own?

Unlike other osteochondroses, Freiberg's disease can leave consequences if untreated: the deformed metatarsal head can cause metatarsophalangeal arthritis. This is why conservative treatment with insoles to offload the affected head is important.

Is surgery needed?

In the vast majority of cases no. Conservative treatment (insoles, appropriate shoes, impact reduction) is effective. Surgery is reserved for rare advanced cases with significant metatarsal head deformity and persistent pain.

Why does it affect girls more?

The reason for the female predominance (3:1) is unclear. Biomechanical factors (longer second metatarsal), footwear (heels, pointed shoes) and hormonal factors are hypothesized. Early recognition is important because it is the only osteochondrosis with risk of arthritic evolution.

Freiberg's disease stands apart among the osteochondroses and deserves special attention: it's the only one that, if not recognized and managed in time, can lead to long-term consequences in the form of arthritis.

It affects the head of the 2nd or 3rd metatarsal (the long bones of the forefoot) and typically presents in female adolescents aged 12 to 18 — with a 3:1 female-to-male ratio thought to be related to biomechanical factors and footwear choices. The main symptom is forefoot pain that appears while walking, running, or wearing narrow shoes or heels.

The mechanism is osteonecrosis: a temporary interruption of blood supply to the metatarsal head causing progressive flattening and, in neglected cases, deformation. X-rays show flattening or fragmentation of the metatarsal head — an image that in early stages may appear normal (in which case MRI is more sensitive).

The good news is that conservative treatment is effective in the vast majority of cases: insoles with a metatarsal pad to offload the affected head, rigid-soled shoes, and avoiding high-impact activities. Surgery is reserved for rare advanced cases. The key message is: early recognition makes a real difference in the prognosis.

When to seek evaluation

Forefoot pain during walking or sports
Pain localized under the second or third metatarsal head
Dorsal forefoot swelling
Limited dorsiflexion of the toes
Pain worsening with heels or narrow shoes

What is evaluated

Palpation of the metatarsal heads
Metatarsophalangeal joint mobility
Foot X-ray (flattening/fragmentation of the metatarsal head)
MRI in early cases (X-ray may be normal initially)
Forefoot biomechanical assessment

Treatment options

Insoles with metatarsal pad (offloading the metatarsal head)
Rigid rocker-bottom sole shoes
Reduction of high-impact activities
Avoid heels or narrow-toed shoes
Surgery in rare advanced cases (debridement, osteotomy)

Frequently Asked Questions

Does Freiberg's disease heal on its own?▼

Is surgery needed?▼

Why does it affect girls more?▼

Other Juvenile Osteochondroses

Osteochondroses are a family of growth-related conditions. Learn about the others:

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Osgood-Schlatter(Knee)

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Sever(Heel)

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Sinding-Larsen(Kneecap)

Complete guide to juvenile osteochondroses →

Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.