Freiberg's Infraction (Osteonecrosis of the Metatarsal Head)

Synopsis
Freiberg's infraction occurs when the end part (head) of the 2nd metatarsal bone (the toe closest to the big toe) in the foot dies due to an inadequate blood supply.  It is more common in girls than boys and most often appears between the ages of 11 and 17 years. The condition happens more often in girls because their second toe is often longer than their 1^st metatarsal.  This means it bears more weight and may be prone to more injury. The condition is often caused by repetitive stress when tiny fractures can occur between the bone and the growth plate.  These tiny breaks interfere with the circulation and not enough blood reaches the bone causing the cells to die.

Symptoms and Treatment
When the condition is first noticed, there is often:

• swelling and tenderness of the toe
• pain in the forefoot, most often on the second toe
  pain made worse by activity
• limited ability to bend the toe

An x-ray may show a flattening of the bone in the early stages.  At this point, treatment may consist of a short leg walking cast and avoidance of strenuous activity, including sports.  The cast often stays on for three to four weeks and eliminates the symptoms.

There is no single definitive treatment for the condition.  While some doctors use casts, others prefer to make adjustments to the shoes and may prescribe orthotics.  Still others may suggest surgery to get rid of any debris in the joint area.  Surgery should be considered only if other treatments have not produced any relief.