Quick answer: Freiberg Disease Avascular Necrosis Metatarsal Head 2 is a clinical condition that responds to evidence-based treatment when caught early. Symptoms include pain, swelling, and altered function. Diagnosis requires clinical exam, often imaging. Treatment ladder: conservative care first (4-6 weeks), then targeted interventions if needed. Call (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: April 2026
In this guide:
The most important clinical decision with Freiberg Disease Avascular Necrosis Metatarsal Head 2 isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
What Is Freiberg Disease?
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Watch: Metatarsalgia Treatment [BEST Ball of Foot Pain RELIEF 2024] — MichiganFootDoctors YouTube
Freiberg disease is an osteochondrosis — a condition of interrupted blood supply to a developing bone — affecting the head of a metatarsal bone, most commonly the second and occasionally the third or fourth. The condition results from repetitive stress causing microvascular injury to the metatarsal head during its growth phase, leading to avascular necrosis, flattening and collapse of the metatarsal head, and eventual secondary arthritic changes in the metatarsophalangeal joint. Freiberg disease most commonly affects adolescent girls and young women, with a female-to-male ratio of approximately 5:1, and typically presents in the second decade of life.
At Balance Foot & Ankle, we evaluate Freiberg disease in patients of all ages — the condition may be diagnosed acutely during the active phase or discovered incidentally in adults with progressive metatarsophalangeal joint arthritic changes that were never diagnosed during adolescence.
Symptoms and Staging
The primary symptom is forefoot pain, swelling, and tenderness directly at the affected metatarsal head, worsened by weight bearing and push-off activities. Pain at the second metatarsal head — approximately 2 inches behind the second toe — is the most characteristic presentation. Range of motion at the metatarsophalangeal joint is reduced compared to the contralateral side. Plain radiographs show the characteristic progressive changes: early sclerosis and flattening of the metatarsal head, followed by fragmentation, central depression, and eventual remodeling with residual deformity. Smillie classification grades the severity from Stage I (early avascular necrosis with normal radiographic appearance — MRI required) through Stage V (complete collapse with secondary arthritic changes).
Conservative Treatment
Early stages (I through III) with preserved metatarsal head contour are managed conservatively to protect the bone during revascularization. Activity modification to reduce forefoot loading, a metatarsal pad to offload the affected head, and custom orthoticss with forefoot accommodation reduce compressive forces during healing. A short-leg walking cast or boot for 4 to 6 weeks is indicated for acute presentations with severe pain to allow initial revascularization. Most patients with early-stage disease treated conservatively experience gradual improvement over 6 to 18 months as the metatarsal head reconstitutes.
When to see a podiatrist for forefoot pain:
- Pain at the ball of the foot that worsens with walking or standing
- Swelling at the base of the second or third toe
- Stiffness or limited motion in a toe joint
- Pain that doesn’t improve with rest and shoe changes after 2 weeks
- Clicking or catching sensation at the metatarsal head
Surgical Treatment
Advanced stage disease with significant metatarsal head deformity, joint incongruity, or secondary arthritis that has failed conservative management may require surgical intervention. Dorsiflexion osteotomy of the metatarsal neck rotates the relatively preserved plantar cartilage into the weight-bearing position and is the preferred procedure for stages III and IV. Joint debridement with synovectomy, loose body removal, and limited bone grafting addresses Stage III disease with retained structural integrity. Stage V disease with end-stage arthritis may require metatarsal head resection with soft tissue interposition or Weil osteotomy to decompress the joint. Our surgical planning is based on the specific stage and patient activity requirements.
Recommended Products for Freiberg Disease
In our clinic, we recommend these products for patients managing Freiberg disease symptoms:
Powerstep Pinnacle Insoles — Built-in metatarsal support helps redistribute pressure away from the affected metatarsal head. A practical first step before investing in custom orthotics.
TheraBand Foot Roller — Gentle plantar massage maintains flexibility in the intrinsic foot muscles and reduces compensatory strain around the affected joint.
PowerStep Maxx Insoles — Maximum arch support with a deeper heel cup for patients with Freiberg disease who also have flat feet or overpronation contributing to increased metatarsal loading.
More Podiatrist-Recommended Foot Health Essentials
Hoka Clifton 10
Max-cushion everyday shoe — podiatrist favorite for walking and running.
OOFOS Recovery Slide
Impact-absorbing recovery sandal — wear after long days on your feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
Is Freiberg disease permanent?
The bone changes from avascular necrosis are permanent, but symptoms can be effectively managed. Early-stage disease responds well to offloading with orthotics. Even advanced cases can achieve good pain relief through surgical joint restoration.
Who gets Freiberg disease?
It most commonly affects adolescent females during growth spurts, particularly those in high-impact sports like gymnastics and dance. Adults can develop it from repetitive overloading of the forefoot in heeled shoes or occupational activities.
Can I still exercise with Freiberg disease?
Low-impact activities like swimming and cycling are usually well tolerated. Running and jumping should be modified based on symptoms. A podiatrist can design an activity plan with physical therapy that maintains fitness while protecting the affected joint.
The Bottom Line
Freiberg disease is an uncommon but treatable cause of forefoot pain that responds best to early intervention. In our Howell and Bloomfield Hills clinics, we use advanced imaging and staged treatment protocols to preserve joint function whenever possible. If you have persistent pain at the ball of your foot that worsens with activity, schedule a podiatric evaluation before the joint damage progresses.
Forefoot Pain? Get a Diagnosis
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Freiberg Disease Treatment in Michigan
Freiberg disease causes forefoot pain from avascular necrosis of a metatarsal head, most commonly in adolescent girls and active adults. Our podiatrists offer conservative and surgical options at our Howell and Bloomfield Hills offices.
Learn About Forefoot Pain Treatment | Book Your Appointment | Call (810) 206-1402
Clinical References
- Gauthier G, Elbaz R. Freiberg’s infraction: a subchondral bone fatigue fracture. A new surgical treatment. Clin Orthop Relat Res. 1979;(142):93-95.
- Smillie IS. Freiberg’s infraction (Kohler’s second disease). J Bone Joint Surg Br. 1957;39(3):580-582.
- Kinnard P, Lirette R. Freiberg’s disease and dorsiflexion osteotomy. J Bone Joint Surg Br. 1991;73(5):864-865.
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Howell Office
4330 E Grand River Ave
Howell, MI 48843
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Bloomfield Hills Office
43494 Woodward Ave, Suite 208
Bloomfield Hills, MI 48302
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Book Your AppointmentWhen Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
★ DR. TOM’S COMPLETE 2026 ORTHOTIC RANKING
9 Best Prefab Orthotics by Use Case
PowerStep, Currex, Spenco, Vionic, and Superfeet — every orthotic I’ve fitted to thousands of patients across both Michigan offices. Each card includes pros, cons, and the specific patient I’d give it to. Real Amazon ratings, review counts, and prices below.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- Lower price than Superfeet Green for equivalent function
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than Superfeet for 90% of patients, which is why I swapped it into our clinic kits three years ago. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
Superfeet’s slim version of their famous Green insole. The trademark stabilizer cap is preserved but the overall thickness is reduced — works in cycling shoes, hockey skates, ski boots, and other tight-fitting footwear that the standard Superfeet Green can’t fit into.
✓ Pros
- Stabilizer cap centers the heel (Superfeet’s signature feature)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
Schedule a Custom Orthotic Fitting →FSA/HSA eligible · Most insurance accepted · (810) 206-1402
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your metatarsal pain, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Same-day appointments available. (810) 206-1402
Doctor Hoy’s Natural Pain Relief Gel
Natural topical pain relief I use in our clinic. Arnica + camphor formula — apply directly to the area 3–4x daily. ($20–25)
Shop Doctor Hoy’s →Frequently Asked Questions
What causes this condition?
Causes include mechanical stress, biomechanical imbalance, age-related changes, and sometimes systemic disease. Our clinical exam plus imaging identifies the specific driver.
Can it go away on its own?
Mild cases sometimes resolve with rest and supportive footwear. Persistent symptoms past 4-6 weeks rarely resolve without active treatment.
PubMed: Freiberg Disease — Metatarsal Head Necrosis
Is surgery required?
Most patients resolve with non-surgical care. Surgery is reserved for refractory cases or structural deformity.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.