Freiberg's Disease: Ball of the Foot Breakdown

Dr. Robert Parker
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Dr. Parker is a podiatrist and surgeon in Houston, TX who has been helping patients for more than 40 years.

If you stood on the surface of a frozen pond, but could hear the ice cracking beneath you, would you call that surface stable? No, and you would probably get off the ice as quickly as you could. Structures that are already breaking down cannot support much weight. They risk collapsing completely. That is the problem in your forefoot when you have Freiberg’s disease.

Example of a Freiberg's Disease ImplantCollapsing Metatarsal Heads

Freiberg’s disease is a rare bone condition that causes the painful flattening and collapse of the second or third metatarsal head, where the metatarsal meets the toe. No one is entirely sure what causes the condition to develop. In some cases the problem is traumatic—an injury damages the surface of the bone and causes its slow breakdown. In others, the condition can be related to metatarsals that are abnormally long, biomechanics that overload the affected toe, and disturbances of the growth plate. However it happens, though, the result is the same: the surface of the bone slowly crumbles.

This condition is most common in active adolescents, particularly girls, though anyone at any age can develop the issue. The pain in the ball of the foot typically worsens slowly, as the bone deteriorates. You’ll feel discomfort particularly when you’re active or spend an extended period of time on your feet. The range-of-motion in the forefoot will decrease and the affected area may be tender to the touch. Sometimes calluses form under the ball of the foot from the pressure. You may experience swelling as well as develop a limp.

Restoring the Bone Tissue

Freiberg’s disease does need to be treated to prevent permanent side effects, like continued degenerative joint disease. Catching and treating the problem early can help restore the forefoot and let you return to your favorite activities pain-free. Dr. Robert Parker will use a variety of tests and diagnostic images such as x-rays or MRI to evaluate your metatarsal heads and check for damage. Once the problem has been diagnosed, you can begin treatment.

When the condition is caught early enough, conservative measures are usually effective. You’ll need to immobilize your foot in a stiff-soled shoe or walking cast for roughly four to six weeks. You may or may not need crutches to avoid putting weight on the foot, but you will definitely need to take a break from all hard-impact activities. Icing and physical therapy may help decrease inflammation and encourage healing as well.

Once the pain has resolved and the bone has recovered, you can begin easing back into your activities. Start slowly and move from low-impact exercises, like biking and swimming, to harder-impact ones. You’ll also need to make adjustments to your footwear in order to protect the affected area. Orthotics will help with this, providing extra cushion and an additional layer of protection, as well as reducing the pressure on your forefoot.

Implant for Freiberg's DiseaseIf conservative treatment is failing, you may need surgery to save or replace the joint. Procedures will remove any loose bone pieces and repair the joint tissues as much as possible. This could include raising the metatarsal head, grafting in healthy tissue, remodeling the bone, and debriding the head to resection it, and Dr.Parker has special training and extensive experience in joint replacement procedures for Freiberg’s Disease, such as the Arthrosurface implant. Which procedure will best benefit you will depend entirely on the extent of the damage and your unique needs.

Freiberg’s disease is rare and can cause serious damage to your forefoot, compromising your ability to push off the ground normally. Left on its own, it could create permanent arthritic changes in the ball of the foot. Don’t wait until you’re limping to seek help for this problem. Let Dr. Robert Parker at Parker Foot & Ankle in Houston, TX, help identify and manage the issue. Call (281) 497-2850 or submit a request through the website to reach us for an appointment.