Health condition
Freiberg disease
Freiberg disease is avascular necrosis of a metatarsal head - usually the second - classically affecting adolescent girls and young women, causing forefoot pain with walking; early offloading can prevent joint collapse, and surgical options exist for established deformity.
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key facts
The essentials at a glance.
The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.
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Pain under the ball of the foot centred on the second (occasionally third) metatarsal head, worse in heels and on tiptoe, sometimes with swelling and stiffness of the toe joint
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Most common in active adolescent girls and women under 30; repetitive loading of a long second metatarsal is the suspected mechanism
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X-rays show flattening, sclerosis and eventually fragmentation of the metatarsal head; MRI detects earlier pre-collapse disease
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Early treatment - stiff-soled shoes, metatarsal padding, activity modification or a walking boot - protects the joint; surgery (debridement, dorsiflexion osteotomy, rarely joint replacement) addresses persistent pain or deformity
Understanding the condition
What it is and what happens next.
What causes it, how it is diagnosed, and the treatment routes available in the UK.
What it is and how it feels
The second metatarsal head takes peak pressure through push-off, and in Freiberg disease its subchondral bone loses blood supply during the vulnerable years of skeletal maturity: the joint surface softens, flattens and can shear off a cartilage flap, converting a focal osteonecrosis into early osteoarthritis of a joint loaded with every step. Presentations range from an active teenager’s "stone bruise that never settles" to adults discovering an old, deformed metatarsal head behind years of intermittent metatarsalgia.
Diagnosis and treatment routes
Diagnosis is confirmed radiographically and staged by the degree of collapse, with MRI reserved for early X-ray-negative pain. Conservative care genuinely alters the course when started early - a period of protected weight-bearing followed by permanent sensible footwear engineering (rocker soles, metatarsal domes, orthoses) - while surgery for the established painful joint ranges from arthroscopic or open debridement of loose fragments to a dorsiflexion osteotomy that rotates preserved plantar cartilage into the working arc of the joint. In much of the UK, a routine NHS referral to the relevant specialist clinic can take several months, whereas an initial appointment with a private consultant is typically available within around two weeks.
Seeing a specialist
Who to see, and how quickly you can be seen.
The specialist for this condition is usually a consultant foot and ankle surgeon. Your GP can refer you on the NHS, or you can arrange a private consultation directly.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.
Frequently asked
Common questions about Freiberg disease.
Quick, plain-English answers to what people ask us most.
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Can you explain what freiberg disease is?
Freiberg disease refers to a recognised clinical condition that a GP or specialist assesses using your history, examination and, if appropriate, targeted investigations. The way it presents and its impact can vary considerably from person to person.
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What causes freiberg disease?
Freiberg disease can arise from several different underlying mechanisms, and in many cases more than one factor contributes. Identifying likely causes usually forms part of the initial specialist work-up.
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What does freiberg disease look like?
Symptoms of freiberg disease vary from person to person and can range from mild and easily missed to significant enough to affect daily life. Because overlapping conditions can produce similar symptoms, a clinical assessment is the most reliable way to confirm what's actually going on.
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Can freiberg disease cause complications?
Most cases of freiberg disease are manageable with appropriate care, though, like many conditions, it can occasionally lead to complications if left unassessed or untreated. Your clinician can give you a realistic sense of the risks based on your specific presentation.
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Is freiberg disease hereditary or genetic?
Many forms of freiberg disease have a genetic or inherited component, and some are linked to specific gene changes that can run in families. If there's a family history, genetic counselling can help clarify the pattern of inheritance and whether relatives might benefit from testing.
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Is there a cure for freiberg disease?
Freiberg disease can often be managed effectively, and in some cases prevented or reversed, with the right combination of lifestyle changes, medication or other targeted treatment. A specialist will tailor the approach to your circumstances rather than applying a one-size-fits-all plan.
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How is freiberg disease treated?
Treatment for freiberg disease is usually built around the severity of your symptoms and any underlying cause found on assessment, and may involve lifestyle measures, medication, physiotherapy or, in some cases, a procedure. Your specialist will discuss the pros and cons of each option with you before agreeing a plan.
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What's the outlook for freiberg disease?
The outlook for freiberg disease varies widely depending on the underlying cause, how early it's diagnosed, and how it responds to treatment. Many people see significant improvement with appropriate care, and your specialist can give you a more personalised timeframe once they've reviewed your case.
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Could freiberg disease be confused with another condition?
Because several conditions can share similar symptoms to freiberg disease, clinicians often consider a short list of possibilities before confirming a diagnosis. This is one of the main reasons a proper assessment, and sometimes targeted tests, matters more than relying on symptoms alone.
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When should I see a doctor about freiberg disease, and how quickly can I be seen privately?
It's worth seeking medical advice if symptoms of freiberg disease are persistent, worsening, or affecting your daily life, rather than waiting for them to resolve on their own. NHS routine referrals for this kind of assessment can take anywhere from around 20 to 45+ weeks, whereas private consultants typically offer an appointment within about two weeks.