Avascular Necrosis: Freiberg’s Disease

Avascular necrosis is characterized by a fracture and collapse of the metatarsal head. This causes the rounded end of the bone to flatten out, and leads to a reduction or loss of blood flow to the toe.


It usually occurs in the second metatarsal (the toe next to the big toe), but it can occur in the third or even fourth toes as well.


Our dedicated team of experts pride themselves in offering the most advanced, comprehensive and compassionate care to our pediatric patients. They are committed to get your child back into action and doing what they love, with the least invasive treatment possible.

Causes of Avascular Necrosis

Avascular necrosis, also known as Freiberg’s disease or Freiberg’s Infarction or Infraction, is a painful condition that frequently affects young athletes, especially teenaged girls.


The causes of a particular case of avascular necrosis are difficult to pin down, but the condition is often caused by overuse and repetitive stress to the area, or what specialists refer to as “chronic microtrauma.” Runners, soccer players, and dancers tend to be especially vulnerable to Freiberg’s disease.


Symptoms of Avascular Necrosis

Because the injury develops over a long period of time, it may be tough to detect avascular necrosis early on. If your child is complaining of these symptoms, you may want to have him or her evaluated by a foot and ankle specialist:

  • Dull aching in the front of the foot
  • Redness and swelling at the metatarsal head
  • Pain when the toes are repeatedly bent
  • Stiffness in the affected toe
  • Symptoms in one or both feet
  • Tenderness in the metatarsal head (at the base of the toe)
  • Limping
  • Symptoms that start out as mild, but worsen over time
  • Symptoms progress to chronic debilitation


Treating Youth Avascular Necrosis

Avascular necrosis is easiest to treat when it is caught early. However, due to the progressive nature of the condition, many patients fail to come in for evaluation until symptoms have already become debilitating.


In adults, severe cases of avascular necrosis may require surgery, but treatment is trickier for children and teens because their feet haven’t stopped growing yet. The common surgical techniques used on adults – osteotomy or bone/cartilage transplant – might damage a young patient’s growth plate and stunt growth in the bone.


For this reason, UFAI specialists recommend a non-invasive course of treatment to limit motion in the joint and relieve symptoms until the growth plate closes, at which time surgery may be recommended. In the meantime, your child’s doctor may recommend rigid soled shoes and custom fitted orthotics with the metatarsal head cut out.


Avascular Necrosis Surgery

Your specialist will keep a close watch on your child’s injury and bone development while the area heals. After a few months or years, when the growth plate has closed, one or more surgical procedures may be performed; the correct procedures will be prescribed based on your child’s individual case:

  • Joint clean-up. This procedure involves the removal of loose bones and spurs in the joint.
  • Bone and/or cartilage replacement. Healthy issue from elsewhere in the foot is grafted onto the collapsed metatarsal head.
  • Implant. A surgical implant is secured onto the metatarsal bone.
  • Metatarsal head resection. A last resort technique that is not typically performed on younger patients, this procedure involves removal of the bone and replacement of a surgical filler to maintain the length of the toe.
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