Rigid Inserts for Freiberg’s disease

Freiberg’s disease or Freiberg’s infarction is a reasonably frequent painful problem of the lesser metatarsophalangeal joints in the foot. It most commonly affects the second joint next to the big toe joint. It typically causes the joint to flatten and collapse like a crushed eggshell would if you hit it with a spoon. It is most common between the ages of 11 to 17 yrs, but can happen at older ages and the consequences of the conditions can persist for many years beyond that age group.

The joint behind the toe is typically very painful when walking on it, tender to palpation of the joint and the movement of the joint can be quite painful. There may be some swelling on the top of the foot. An x-ray or other imaging will typically demonstrate a flat appearance of the head of the metatarsal bone (due to that ‘crushed egg shell’ appearance). See this x-ray:

The exact cause of Freiberg’s is not so clear, but it is assumed that it is most likely due to overuse (eg too much sport) in those who are prone to it, for example having a longer metatarsal that gets more pressure on it.

The treatment of this condition typically starts some level of activity limitation and perhaps accommodative padding (eg made from felt) in order to relieve pressure on the painful joint. The toe could have tape applied to restrict or reduce its movements. In the more painful cases, a walking brace, such as a moon boot can be used for a month or so. At the end stages and if none of these conservative approaches help, then there are a couple of surgical options.

You can often see advice that it is better to use a stiffer-soled shoe or a rigid carbon plate in the shoe to make the shoe stiffer or more rigid. Often those with this condition do note that it is not as painful in their more rigid footwear compared to the flexible types of footwear. The logic underpinning this is that if flexion of the toe is painful when you have Freiberg’s disease, then limiting the amount the foot can flex at the affected joint will help reduce the pain and help facilitate healing. That is the aim of the rigid carbon plates to restrict that motion across the ball of the foot.

Shoe stiffening inserts for Freiberg’s disease:

For the latest on research on this, check the Freiberg’s disease thread on Podiatry Arena.

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