It is avascular necrosis (bone death due to a lack of blood supply) of the head of the second metatarsal bone in the foot. The bone loses its blood supply, weakens, and progressively deforms. It was first described by Dr. Albert Freiberg in 1914 and primarily affects young women. The second metatarsal is affected in 68% of cases, although it can also occur in the third or fourth metatarsal.

No. Metatarsalgia is a general term used to describe any pain in the metatarsal region of the foot. Freiberg’s disease is a specific cause of metatarsalgia: bone necrosis accompanied by progressive joint deformity. There are many other causes of metatarsalgia (mechanical overload, Morton’s neuroma, sesamoiditis, etc.). An accurate differential diagnosis using X-rays is essential for administering the appropriate treatment.

No direct hereditary pattern has been demonstrated. However, predisposing anatomical factors (such as a longer second metatarsal or an underdeveloped first metatarsal) may have a familial genetic component. If there is a family history of metatarsal problems, it is advisable to monitor the forefoot, especially during adolescence.

Yes, although it is rare. Approximately 6–10% of cases are bilateral. In patients with bilateral involvement, a comprehensive biomechanical evaluation should be performed to identify and correct predisposing factors (metatarsal configuration, biomechanics of the first ray) and prevent progression in the less affected foot.

In the early stages (Smillie I–II), conservative treatment with pressure-relieving insoles, footwear modifications, and reducing high-impact activities may be sufficient to halt progression and relieve pain. However, if the disease progresses to stages III–V with established joint deformity, surgery is usually necessary to restore function and eliminate chronic pain.

The procedure is performed under local anesthesia, so you will not feel any pain during the procedure. After surgery, discomfort is moderate and can be managed with oral pain medication for the first 3–5 days. Most patients describe the postoperative period as much less painful than they expected. Furthermore, since no screws or osteosynthesis hardware are used, there is no need for a second procedure to remove them.

In our minimally invasive approach, we do not use screws, plates, or pins. Percutaneous osteotomy is stabilized by the intrinsic stability of the bone cut and a functional bandage. This eliminates the need for a second surgery to remove hardware and reduces postoperative discomfort.

Patients can begin walking in postoperative shoes immediately. Full weight-bearing without restrictions is typically achieved between 4 and 6 weeks. A return to sports usually occurs between 2 and 3 months. The final functional outcome is assessed at 6 months, when bone union is complete. These timeframes may vary depending on the technique used and the initial condition.

Yes. One of the main goals of treatment is to restore athletic ability. With dorsiflexion osteotomy, the joint is repositioned to support functional weight-bearing. Most athletic patients resume their usual activities (running, hiking, tennis, ballet) between 2 and 3 months after surgery. It is recommended to supplement recovery with custom insoles to optimize weight distribution.

For the first 3–4 weeks, you should wear rigid postoperative shoes to protect the osteotomy site while it heals. After that, we recommend shoes with a semi-rigid sole, a wide last, and good cushioning. It is essential to avoid high heels (>3 cm), as they shift the weight to the forefoot. The custom insoles with metatarsal relief that we make at the clinic are an ideal complement for protecting the joint in the long term.