Ball of Foot Pain – Freiberg's Infraction

Freiberg’s Infraction is a rare condition. It occurs when the head of the bone of the second toe has a focal loss of blood supply. This is known as ‘avascular necrosis’. 

This condition occurs in the second metatarsal bone. This is the long bone in the foot closest to the big toe. This condition can also occur in the third or fourth toe but is less common. 

Freiberg’s Infraction is a lot more common in girls than boys. It usually occurs in young girls between the ages of 11 and 17 years old. However, it may remain undiagnosed until later in life when the patient becomes more active. This condition can also occur in people in whom the bone connected to the base of the big toe (the first metatarsal bone) is short or the second metatarsal bone is long. In both cases, the second metatarsal head can be subjected to repeated stresses such as during dancing, jogging, or running.

Symptoms

Patients with this condition will typically complain of pain during activity, particularly when pushing off of the foot, or when wearing high-heeled shoes.

Other symptoms include:

  • Pain and stiffness in the front of the foot 
  • A limp 
  • Swelling
  • Tenderness
  • Limited range of motion (stiffness)
  • Feeling like walking on a stone 
X-Ray showing FI of the 2nd Metatarsal Head

Causes

 The exact cause of this condition is poorly understood. It may occur due to:

  • Rapid growth of the bones (this is why it usually occurs in young patients) 
  • Injury to the area 

Treatment

The primary goal of treatment is to rest the area to reduce the pain and swelling. Treatment plans generally depend on the severity of the condition. 

  1. Rest: rest is the main treatment for this condition. This may mean the patient will have to take a break from sporting activities for ideally 4-6 weeks. Return to activity should be gradual after this break. 
  2. NSAIDs: Non-steroidal anti-inflammatory drugs such as ibuprofen to reduce pain and inflammation. 
  3. Podiatrists at South Dublin Podiatry may prescribe custom foot orthotics to help take the pressure of this painful joint when walking and allow it to heal.
  4. Footwear Change: Low-heeled shoes, possibly those that have thicker soles than normal and rounded heels (called rocker sole modifications) may be helpful.
  5. Some patients may need offloading devices such as casts and crutches, depending on the severity of the condition.
  6. Corticosteroid injections.
  7. In rare cases, if other treatments aren’t successful then surgery may be an option.

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