Toe Conditions: All about Avascular Necrosis / Frieberg's Infarction

Avascular Necrosis

Avascular necrosis of the metatarsal head, commonly known as Frieberg’s infarction, is a painful condition that is commonly misdiagnosed. The good news for sufferers is that the University Foot and Ankle Institute has revolutionized the treatment of this difficult problem.


It can occur when there is an interruption of the blood supply to a toe. When this happens the tissue dies and the bone collapses. Left untreated, it can lead to destruction of the toe’s joint surface.

UFAI operates on the cutting edge of foot and ankle bone disease treatment. In addition to helping patients overcome their foot and ankle challenges, our physicians regularly teach others the most innovative treatment techniques.


The cause of metatarsal avascular necrosis or Frieberg's Infarction is not fully understood, but risk factors include chemotherapy, alcohol abuse, excessive steroid use, vascular compression and high blood pressure.


Frieberg's Infarction seems to be due to chronic micro-trauma and overload of the metatarsal head. This leads to fracture and collapse of the metatarsal head and decreased or loss of circulation to the collapsed area. Over time, arthritis and pain develop.


Avascular Necrosis - University Foot and Ankle Institute

Treatment options for Frieberg's Infarction


Boot, cast and orthotics

Conservative care for Frieberg’s infarction is offered by offloading of the area. During the active period of pain and early collapse, the patient is often placed in a boot or cast and on crutches to limit or completely remove weight from the metatarsal head. With time, an orthotic is made to decrease the abnormal pressure through the metatarsal head.


Spur removal and resurfacing

If there is a collapse and early arthritis noted, three procedures are used to salvage the joint. The first removes all loose bone and spurs in the joint. In more advanced cases, the spurs are removed and the metatarsal head is shortened to decrease the abnormal stress throughout the area. In cases of more advanced cartilage damage, the cartilage from the bottom of the joint is tilted upwards to resurface the joint and remove the damaged cartilage on the top of the joint.


It should be noted that the University Foot and Ankle Institute is one of only a few centers in the world experienced in resurfacing of the metatarsal head. We have extensive experience with avascular necrosis of metatarsal heads and cater our treatment to the individual needs and goals of the patient.



Why choose UFAI's podiatrists for the treatment of Metatarsal Avascular Necrosis?


The University Foot and Ankle Institute operates on the cutting edge of bone disease treatment. In addition to helping patients overcome foot and ankle challenges, our physicians teach other doctors our innovative procedures. Request an appointment at one of our Los Angeles or other Southern California offices. We are here to help.


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