Paediatric Orthopaedic Specialist
Freiberg disease (active management)
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
For whom: After diagnosis of Freiberg disease and definition of permitted loading. Avoid painful forefoot pressure, jumps and forced mobilisation of the affected joint.
Dose and frequency: Perform only the exercises selected during the visit. The listed dosages are examples to adapt: follow the dose, frequency, rest and progression prescribed for age, symptoms and phase. Do not automatically perform the whole list.
Equipment and supervision: A stable, clear surface, comfortable clothing and a secure support. Check resistance-band anchors. Adult supervision; avoid marbles and small objects if the child may put them in their mouth, using a towel instead.
Avoid: Forcing a painful or unauthorised movement; Increasing load, resistance or frequency without the agreed rest periods; Doing balance exercises without stable support or supervision.
1.Gentle toe mobilization
Maintains mobility of the involved metatarsophalangeal joint
Seated, grasp the affected toe (usually 2nd or 3rd) with one hand and metatarsal head with the other. GENTLY move toe in flexion/extension, without forcing range. Goal is to maintain joint mobility, not force increase. Slow, pain-free movements.
10 gentle reps, twice daily
2.Ball massage (avoiding painful area)
Reduces tension in the sole of the foot
Seated, roll tennis ball under sole focusing on arch and heel, AVOIDING pressing directly on painful metatarsal area. Massage relaxes plantar muscles and improves circulation without irritating inflamed area.
3-5 minutes per foot, once daily
3.Intrinsic muscle strengthening (towel curls)
Strengthens muscles supporting arch and offloading forefoot
Seated, foot on towel spread on floor. Using only toes, "curl" towel toward you. Then pick up small objects with toes. These exercises strengthen deep muscles that help redistribute forefoot load, reducing pressure on involved metatarsal head.
3 sets, 1-2 times daily
4.Calf stretch
Tight calf increases forefoot loading
Facing wall, leg to stretch behind. Gastrocnemius: straight knee. Soleus: bent knee. Push hips forward feeling stretch. A tight calf forces foot to load forefoot more during gait, worsening Freiberg symptoms.
3 × 30 seconds per position, twice daily
5.Toe yoga (toe control)
Improves selective toe control and load distribution
Seated, foot flat on the floor. Lift only the big toe keeping the others down, then reverse by lifting the four outer toes and keeping the big toe down. Slow, controlled movements. Better toe control helps modulate pressure on the affected metatarsal head.
15 reps per movement, twice daily
6.Toe spreading (toe spreads)
Toe mobility and control without changing the distance between metatarsal heads.
While sitting, gently spread the toes without pushing them with your hands, hold briefly and relax. The affected joint should remain pain-free. Do not force with separators to “create space” between the metatarsal heads.
10-15 reps, twice daily
7.Ankle strengthening with band (4 directions)
Maintains ankle strength while loading is reduced
Seated with a band around the foot. Perform the four movements against resistance: dorsiflexion, plantarflexion, inversion, eversion. Slow movement, only at the ankle, without knee compensation. Perform plantarflexion without pushing with the toes so the forefoot is not loaded.
3 × 12-15 each direction
8.Low-impact activities
Maintains fitness without forefoot impact
Choose activities compatible with the permitted loading and without pain. If cycling is allowed, check with the physiotherapist that the pedal supports the midfoot without pressing on the painful joint; remain seated and use low resistance. Stop if pain occurs. In the pool, follow restrictions on pushing off the wall, entry and exit.
20-30 minutes, 2-3 times weekly
9.Single-leg balance
Restores foot control before return to sport
Only after weight bearing is authorised: begin on both feet near a stable support with a natural, pain-free stance. Progress to one leg if tolerated without deliberately shifting weight onto the outer border. Keep the eyes open. If forefoot pain occurs, stop and have the loading plan reassessed.
3 × 20-30 seconds per leg
10.Gradual return to load and sport
Protected progression with metatarsal offloading
1) Walking with rigid-soled shoes and an insole with a metatarsal bar (offloading the metatarsal head). 2) Gradual distance increase. 3) Light straight-line running only when walking is completely pain-free. 4) Jumping and direction changes reintroduced last. Rule: no pain during activity or in the following 24 hours.
Individualized progression, guidance during visit
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
- A red or hot joint, or inability to bear weight: seek prompt assessment; use emergency care if severe.
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Paediatric Orthopaedics - ASST Gaetano Pini-CTO
Content version: 9 September 2026
ortopediaevolutiva.com • Printed: 13/09/2026
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Before You Start
Who is this guide for?
After diagnosis of Freiberg disease and definition of permitted loading. Avoid painful forefoot pressure, jumps and forced mobilisation of the affected joint.
What you need
A stable, clear surface, comfortable clothing and a secure support. Check resistance-band anchors. Adult supervision; avoid marbles and small objects if the child may put them in their mouth, using a towel instead.
Suggested frequency
Perform only the exercises selected during the visit. The listed dosages are examples to adapt: follow the dose, frequency, rest and progression prescribed for age, symptoms and phase. Do not automatically perform the whole list.
Common mistakes to avoid
- •Forcing a painful or unauthorised movement
- •Increasing load, resistance or frequency without the agreed rest periods
- •Doing balance exercises without stable support or supervision
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
- A red or hot joint, or inability to bear weight: seek prompt assessment; use emergency care if severe.
Detailed Exercises
- 1
Gentle toe mobilization
Maintains mobility of the involved metatarsophalangeal joint
Seated, grasp the affected toe (usually 2nd or 3rd) with one hand and metatarsal head with the other. GENTLY move toe in flexion/extension, without forcing range. Goal is to maintain joint mobility, not force increase. Slow, pain-free movements.
10 gentle reps, twice daily - 2
Ball massage (avoiding painful area)
Reduces tension in the sole of the foot
Seated, roll tennis ball under sole focusing on arch and heel, AVOIDING pressing directly on painful metatarsal area. Massage relaxes plantar muscles and improves circulation without irritating inflamed area.
3-5 minutes per foot, once daily - 3
Intrinsic muscle strengthening (towel curls)
Strengthens muscles supporting arch and offloading forefoot
Seated, foot on towel spread on floor. Using only toes, "curl" towel toward you. Then pick up small objects with toes. These exercises strengthen deep muscles that help redistribute forefoot load, reducing pressure on involved metatarsal head.
3 sets, 1-2 times daily - 4
Calf stretch
Tight calf increases forefoot loading
Facing wall, leg to stretch behind. Gastrocnemius: straight knee. Soleus: bent knee. Push hips forward feeling stretch. A tight calf forces foot to load forefoot more during gait, worsening Freiberg symptoms.
3 × 30 seconds per position, twice daily - 5
Toe yoga (toe control)
Improves selective toe control and load distribution
Seated, foot flat on the floor. Lift only the big toe keeping the others down, then reverse by lifting the four outer toes and keeping the big toe down. Slow, controlled movements. Better toe control helps modulate pressure on the affected metatarsal head.
15 reps per movement, twice daily - 6
Toe spreading (toe spreads)
Toe mobility and control without changing the distance between metatarsal heads.
While sitting, gently spread the toes without pushing them with your hands, hold briefly and relax. The affected joint should remain pain-free. Do not force with separators to “create space” between the metatarsal heads.
10-15 reps, twice daily - 7
Ankle strengthening with band (4 directions)
Maintains ankle strength while loading is reduced
Seated with a band around the foot. Perform the four movements against resistance: dorsiflexion, plantarflexion, inversion, eversion. Slow movement, only at the ankle, without knee compensation. Perform plantarflexion without pushing with the toes so the forefoot is not loaded.
3 × 12-15 each direction - 8
Low-impact activities
Maintains fitness without forefoot impact
Choose activities compatible with the permitted loading and without pain. If cycling is allowed, check with the physiotherapist that the pedal supports the midfoot without pressing on the painful joint; remain seated and use low resistance. Stop if pain occurs. In the pool, follow restrictions on pushing off the wall, entry and exit.
20-30 minutes, 2-3 times weekly - 9
Single-leg balance
Restores foot control before return to sport
Only after weight bearing is authorised: begin on both feet near a stable support with a natural, pain-free stance. Progress to one leg if tolerated without deliberately shifting weight onto the outer border. Keep the eyes open. If forefoot pain occurs, stop and have the loading plan reassessed.
3 × 20-30 seconds per leg - 10
Gradual return to load and sport
Protected progression with metatarsal offloading
1) Walking with rigid-soled shoes and an insole with a metatarsal bar (offloading the metatarsal head). 2) Gradual distance increase. 3) Light straight-line running only when walking is completely pain-free. 4) Jumping and direction changes reintroduced last. Rule: no pain during activity or in the following 24 hours.
Individualized progression, guidance during visit
Frequently Asked Questions
Can I do sports with Freiberg disease?
In the acute phase, activities loading the forefoot must be reduced: running, jumping, sprinting sports. Swimming and cycling are generally tolerated. Return to sport occurs gradually when pain resolves, with metatarsal offloading insoles.
