The Center for Podiatric Care and Sports Medicine

An Infraction Called Freiberg

Posted by on Thursday, August 16th, 2012


At some point in your life, you may have committed an infraction. Hopefully you were sorry. Now what if your foot was the one with the infraction?

Let’s look at the meaning of this so very interesting word. Here are the definitions from

1. breach; violation; infringement: an infraction of the rules.
2. Medicine/Medical . an incomplete fracture of a bone.
Bet you knew about the first one, but how about that second meaning? That’s the one where going to consider today, with the strange case of the Freiberg’s Infraction.
What is a Freiberg’s Infraction? Why is it strange? Okay, it’s not that strange; I just thought it sounded mysterious to put it that way. It’s not a common condition, though.
Description…? Yes, I’m getting there.  A Freiberg’s Infraction occurs when poor blood supply to the base of the metatarsal causes the death of the head of the bone, resulting in it’s collapse. It’s also known as Avascular Necrosis, or AVN. Freiberg’s Infraction can affect any of the metatarsals but it is most often found in the second or third; the thought is that since those toes have the least flexibility, they’re least able to take a lot of pounding.
That’s terrible! Why would my bone want to go and die on me? It doesn’t want to;  stop taking everything so personally. The clearest cause is overuse injuries, such as frequent running and jumping, that lead to many small stress fractures. These fractures cause circulation problems which then add up to the Freiberg’s Infraction. Some people may be more predisposed to this, such as those who are overweight, have a long second toe, or have bone or blood circulation issues. Steroid use has been connected to AVN in other bones so it may also play a part in Freiberg’s Infraction. Interestingly, it tends to occur during the teenage years and is more likely to affect females than males.
How would I know I have a Freiberg’s Infraction? Would a motorcycle cop pull me over on the highway to give me a warning that my metatarsal was infracting? Not unless motorcycle cops in your area tend to be psychic podiatrists with x-ray vision (though that would be exciting; hopefully we’ll have that around the same time those jetpacks are in common use). The symptoms are forefoot pain that gets worse during activity; swelling around the toe in question; lack of flexibility in the toe.
Of course those symptoms fit any number of toe and forefoot conditions. The best way to get the correct diagnosis is to see a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900) to get an accurate diagnosis and treatment plan.
Okay, so what do you do about a Freiberg’s Infraction? Can I prevent it by just drinking lots of calcium? Can the dead bone be revived? Are there Zombie Metatarsal Heads? No more than psychic podiatrists with x-ray vision. Treatment generally focuses on relieving pain and pressure on the toe with orthotics and padding. Rest is recommended; sometimes patients may be put into a walking boot or cast for a few weeks to take pressure off the toe.
There are surgical procedures for very advanced or debilitating cases. The most common is to debride, or remove the dead bone, and shift new cartilage into the area. Bone grafts are possible in earlier stages.
Oh, and I know what you’re going to ask next–the Freiberg in question is Alfred H., who first described this condition in 1914.
Good old Alfred H. Indeed.
Here’s the moral of this story: if you feel pain and swelling around the base of any of your toes, but most especially the second or third, get it checked out–you might have a Freiberg Infraction on the way.

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.