Freiberg's disease is a pathological condition resulting in the painful forefoot, which usually affects teenage girls who practise dance and ballet. The exact etiology is unknown, but the disease is often associated with alterations in ossification of the metatarsal head.
Possible causes include trauma, repeated mechanical stress, impaired blood supply and the use of unsuitable footwear. Less than 10% of patients have bilateral involvement. The pain is aggravated by the load of the body weight and from the sport. Frequently there is localized pain on palpation and swelling at the level of the affected metatarsal head.
Plain radiographs may show sclerosis and varying degrees of flattening of the articular surface involved. In the majority of patients a non-surgical treatment, including modification of physical activity and the use of insoles in the footwear, facilitates the regeneration of the metatarsal head and the resolution of symptoms.