Freiberg’s infraction

What is Freiberg's infraction

Freiberg's infraction or Freiberg's disease, most often affects the head of the second metatarsal bone in the foot where it joins the toe, but it can also occur in other toes. Its cause is unclear, but it is thought to be a spontaneous interruption of the blood supply to the bone causing it to soften. This results in the metatarsal head either flattening or collapsing.

Inflammation in the bone can cause pain, swelling and stiffness in the affected toe. Once the inflammation resolves most symptoms will go away, although some stiffness and a small amount of swelling may remain.

The bone will remodel and heal in a process that can take one to two years. Improved outcomes generally occur when the growth plates in the bone are still open. Surgery is not needed in children except for symptoms related to long-lasting changes that may have a negative impact in adulthood.

What are the signs and symptoms of Freiberg's infraction

When putting weight on the affected toe, symptoms may include:

• pain
• swelling
• stiffness

How is Freiberg's infraction diagnosed?

A health-care provider will perform a physical exam of your child's foot. If Freiberg's infraction is suspected, then the patient will also have an X-ray taken of their foot.

How is Freiberg's infraction treated?

If your child is experiencing symptoms, then treatment strategies will include:

• Stopping activities that cause pain such as sports, repetitive activities or high-impact activities (e.g., running, jumping, etc.) for six weeks.
• Wearing a walking boot that helps to support and protect the foot if it is very painful for 4 to 6-weeks.
• Medications such as ibuprofen (e.g., Advil) or naproxen (e.g., Aleve) daily for 4-weeks (it is best if this is done at the same time as resting from activity).

If your child is still experiencing symptoms after six weeks, then a custom accommodative orthotic with a metatarsal pad may be considered. This serves to offload the joint of the affected toe(s).

Repeat imaging with an X-ray is only done every six months until symptoms are gone or significantly improved. This is to make sure the head of the metatarsal bone is healing and remodelling. No further imaging is needed once symptoms are improving.

If your child is still experiencing pain after the initial treatment strategies have been tried for at least six months on a consistent basis, and a review with your health-care provider has been completed, then a referral to orthopaedic surgery may be considered. Freiberg's infraction typically resolves within two years.

At SickKids

At SickKids, we accept referrals for this diagnosis only if there are remaining symptoms after the above treatments have been tried consistently for at least 6 months.