Freibergs Infarction

Experiencing a Freiberg's infraction means that there is an interruption in the blood supply to the end of one of the long bones (metatarsals) in the foot.

What Are The Symptoms Of A Freiberg's Infarction?

The symptoms of a Freiberg’s infraction may include feeling pain at a specific area of the ball of the foot that tends to worsen over the course of many weeks. Most often, it is the second or third metatarsals that are affected. As the pain worsens, we see many people adapt a limping gait in order to help reduce pain as they walk. Wearing heeled shoes may become too painful, and the affected joint may become stiff or swollen.

What Causes A Freiberg's Infarction?

Freiberg’s infractions are thought to develop either from damage to the vascular supply to the metatarsal bone, or from trauma to the bone, which can occur from one large traumatic event (like jumping down from a high surface) or repetitive microtrauma over time (like running). Both of these can lead to damage to the bone and joint, interfering with the structural integrity in the area, and disrupting the blood supply. Anatomical features like having a long second metatarsal bone may also play a role.

What Are The Risk Factors Of Developing A Freiberg's Infarction?

The risk factors associated with developing a Freiberg’s infarction include age (more common in adolescents and young adults), being female, having specific foot structures (e.g., high arch or shorter second metatarsal bone), engaging in repetitive stress activities, having a history of foot injuries, a family history of the condition, having certain medical conditions (e.g., systemic lupus erythematosus), and wearing ill-fitting or high-heeled shoes.

Diagnosing A Freiberg's infarction

Diagnosing a Freiberg's infarction begins with a thorough medical history and physical examination, focusing on the location and nature of the pain, the range of motion in the joints of the feet, a gait assessment and more. X-ray imaging may be used to identify changes in the affected metatarsal bone and joint, revealing any bone density changes or bone damage, particularly to the metatarsal head. 

In some cases, an MRI may be recommended to obtain more detailed images of the foot, and a bone scan can help differentiate Freiberg's infarction from other causes of foot pain. As Freiberg’s can become serious if left untreated, it’s always important to get a formal diagnosis so that the best management and treatment plan can be started, helping you best manage your symptoms and prevent complications.

What Are The Podiatry Treatment Options For A Freiberg's Infarction?

Treating a Freiberg’s infarction focuses on reducing or eliminating your painful symptoms, enabling you to continue to walk and remain mobile comfortably and normally, and helping reduce the impact on the end of the metatarsal so adequate blood flow can be maintained. In order to achieve this, we may use:

  • Custom foot orthotics: foot orthotics that are uniquely prescribed by your podiatrist can go a long way in helping offload the affected joint, redistribute pressure comfortably across the foot, keep the foot supported, and optimise your gait. We’re proud to make extremely high-quality custom foot orthotics, pairing a 3D scan of your foot with a comprehensive exam and gait analysis.
  • Immobilisation: whether it’s using a moon boot or similar device, in severe cases, temporarily immobilising the affected foot may be beneficial to kickstart the healing process by removing any weight and pressure off the affected joint.
  • Activity modifications: especially in the early stages, rest and activity modifications will be an important part of your recovery process to help you best manage your symptoms and start to get some relief. Our podiatrists will discuss simple activity modifications to help best support your recovery, which may include switching from high-intensity exercise to low-intensity exercise such as swimming.
  • Footwear recommendations and modifications: your shoes play a big role in both your gait and how pressure is distributed across your foot, including the heads of the metatarsals. We’ll always evaluate your footwear to ensure that it’s supporting your healing and recovery, and not hindering it. We are also able to make custom footwear modifications, if needed, to best support healing and repair.
  • Physical therapy: depending on the results of your assessment with us, working on stretching and strengthening can help to improve your joint mobility, strengthen surrounding muscles, and improve your gait mechanics - all leading to improved foot function and symptom reduction.
  • MLS laser: laser is a fantastic tool that helps with relieving pain while accelerating healing and repair without the need for medications, needles or surgery.

In severe cases, where sufficient symptom relief or progress cannot be achieved with conservative (non-invasive) measures, corticosteroid injections as well as discussions around the possibility of surgeries including joint debridement, bone reshaping, or joint realignment may be discussed.

What Happens If You Ignore Freiberg's Infarction Symptoms?

Ignoring Freiberg's infarction symptoms can lead to the progression of the condition and potential complications. As the infarction worsens, the affected metatarsal bone can become more damaged, leading to joint deformities, chronic pain, and limited mobility. Without timely intervention, the condition may result in long-term joint damage, arthritis, and difficulties in walking or bearing weight on the affected foot.

How Can You Prevent And Reduce The Risk Of Developing Freiberg's Infarction?

While it may not be entirely preventable, you can reduce the risk of developing a Freiberg's infarction by:

  • Wearing properly fitting footwear with adequate cushioning and support.
  • Avoiding excessive repetitive stress on the forefoot, especially if engaging in activities like running or dancing.
  • Maintaining a healthy lifestyle with a balanced diet and regular exercise to promote overall foot health.
  • Seeking prompt medical attention for any foot injuries or pain, particularly at the ball of the foot.

When Should You See A Podiatrist For Freiberg's Infarction Treatment?

It’s always best to see a podiatrist or a foot and ankle specialist if you experience persistent pain in the ball of your foot that worsens over time, especially if you notice difficulty walking or swelling in the affected area. Generally, we recommend seeing a podiatrist any time you begin to experience foot, ankle or leg pain.

How To Prepare For Your Appointment With A Podiatrist?

The best way to prepare for your appointment with your podiatrist is by being able to recall information about your foot pain such as when it started, its severity, and the symptoms that you’re experiencing. If you’ve had any medical imaging or reports, please bring these along to your appointment. Don’t forget to bring your regular shoes (ideally both casual and exercise shoes) as well as any orthotics that you regularly wear.


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Monday 7:30am - 6:00pm
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