![Freiberg Infraction & Freiberg’S Disease [2Nd Toe Pain Treatment] | Balance Foot & Ankle](https://www.michiganfootdoctors.com/uploads/2023/08/freiberg-infraction-freiberg-s-disease-2nd-toe-pain-treatment.avif)
Quick answer: Freiberg Disease Avascular Necrosis Metatarsal Michigan 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 · Last reviewed: April 2026 · Editorial Policy
The most important clinical decision with Freiberg Disease Avascular Necrosis Metatarsal Michigan isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Quick Answer
Freiberg’s Disease (AVN of the Metatarsal Head): Diagn relates to foot pain — typically caused by overuse, footwear, or biomechanics. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Hills: (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.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Freiberg’s disease is avascular necrosis (AVN) of the second metatarsal head — or less commonly the third metatarsal — where the bone loses its blood supply, collapses, and degenerates, causing progressive ball-of-foot pain, swelling, and MTP joint stiffness. It most commonly affects athletic adolescent girls during growth spurts but can occur in adults from trauma or corticosteroid use. Dr. Tom Biernacki, DPM at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan diagnoses and treats Freiberg’s disease.
What Causes Freiberg’s Disease
The exact cause remains debated, but repetitive microtrauma to the second metatarsal head — from impact loading during the push-off phase of gait and sports — is the most accepted mechanism, particularly in patients with a relatively long second metatarsal (Morton’s foot type). The trauma disrupts the blood supply to the subchondral bone of the metatarsal head, leading to ischemia, bone death, and eventual collapse and fragmentation of the joint surface. Contributing factors include second metatarsal length, high-heeled footwear (which increases second MTP loading), athletic training volume during adolescent growth, and in adults, corticosteroid use which impairs the bone’s blood supply through fat accumulation in the marrow.
Clinical Presentation
Freiberg’s disease presents as insidious onset pain, swelling, and limited motion at the second MTP joint. The joint is tender to palpation, warm, and may have a palpable effusion (fluid in the joint). Dorsiflexion (bending the toe up) is limited and painful. The patient walks with a shortened stride and weight shift to the outer foot to offload the second MTP. In advanced disease, the joint becomes grossly enlarged, irregular, and loose bodies are palpable or audible during joint motion.
Diagnosis and Staging
Smillie’s classification describes five stages: Stage I — early ischemia, subtle MTP changes on X-ray; Stage II — fissuring and flattening of the metatarsal head; Stage III — absorption of central bone, head collapse beginning; Stage IV — loose bodies, severe head deformity; Stage V — complete articular destruction with secondary arthritis. X-rays show progressive metatarsal head flattening and irregularity. MRI is the most sensitive tool for early diagnosis — bone marrow edema pattern in Stage I before X-ray changes are visible. Gadolinium-enhanced MRI can quantify the area of non-perfused bone.
Conservative Treatment
Early-stage Freiberg’s (Stages I-II) responds to conservative management with a goal of offloading the second MTP joint while the bone revascularizes. A metatarsal dome pad placed proximal to the second metatarsal head reduces pressure on the compromised bone. A rigid rocker-bottom shoe or CAM boot reduces MTP dorsiflexion stress during push-off. Activity modification reducing running and jumping during the active phase is essential. Custom orthotics with metatarsal offloading and built-in Morton’s extension reduce second MTP loading during all activities. Duration of conservative treatment is typically 3–6 months, with serial X-rays or MRI monitoring for stage progression.
Surgical Treatment
Surgery is indicated for failure of conservative management, Stage III-IV disease with significant head deformity, and painful loose bodies. Options include joint debridement and loose body removal (arthroscopic), dorsiflexory osteotomy of the second metatarsal (rotating the intact plantar surface of the head to serve as the new articular contact surface — appropriate for Stages III-IV), and in advanced Stage V disease, metatarsal head resection arthroplasty. Dorsiflexory osteotomy has good outcomes for appropriately staged disease — most patients achieve significant pain reduction and preservation of joint motion compared to resection.
Most Common Diagnostic Delay
Freiberg’s disease is commonly diagnosed late because early-stage disease on X-ray appears subtle and the patient presents as “ball of foot pain” — easily attributed to Morton’s neuroma or generic metatarsalgia. The key distinguishing features are: a single metatarsal head specifically involved rather than multiple (Morton’s neuroma is between metatarsals not within a head); limited and painful MTP dorsiflexion on exam (Morton’s neuroma does not restrict MTP motion); and adolescent female patient age and athletic history in most cases. MRI requested for persistent, focal second MTP pain identifies early AVN before X-ray changes and before the intervention window for conservative management closes.
When to See Dr. Biernacki
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See a podiatrist if you have persistent pain and swelling at the base of the second toe that has lasted more than 4–6 weeks and is not responding to rest, particularly if you are an athletic teenager or young adult, or if you have had multiple corticosteroid injections in the area. Dr. Biernacki provides weight-bearing foot X-rays, MRI coordination, custom orthotics with metatarsal offloading, and surgical consultation for advanced stages. Book online or call (810) 206-1402 — Howell and Bloomfield Hills, Michigan.
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Dr. Biernacki and our team at Balance Foot & Ankle are accepting new patients in Howell and Bloomfield Hills, MI. Most insurances accepted.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
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4330 E Grand River Ave
Howell, MI 48843
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Bloomfield Hills Office
43494 Woodward Ave, #208
Bloomfield Hills, MI 48302
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Impact-absorbing recovery sandal — wear after long days on your feet.
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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
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
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Same-day appointments in Howell + Bloomfield Hills. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Hills, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Hoy’s Complete Pain Relief Line — Dr. Tom’s Picks (2026)
Dr. Hoy’s Natural Pain Relief is Dr. Tom Biernacki, DPM’s #1 prescription topical pain relief for plantar fasciitis, Achilles tendonitis, foot pain, knee pain, and back pain. Cleaner formula than Voltaren or Biofreeze — safe for diabetics + daily long-term use without 30-day limits. Below is the complete Dr. Hoy’s product line, organized by use case.
Dr. Hoy’s Natural Pain Relief Gel (4oz Tube)Dr. Tom’s #1 Brand
The flagship Dr. Hoy’s — menthol-based natural pain relief gel. The bottle Dr. Tom hands every plantar fasciitis patient on visit one. Cleaner formula than Voltaren or Biofreeze.
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Dr. Hoy’s Natural Pain Relief Gel (8oz Pump Bottle)Dr. Tom’s #1 Brand
8oz pump bottle — same formula as the 4oz tube but 2x the value. Best for athletes, families, or chronic pain patients who use it daily.
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Dr. Hoy’s Arnica Boost Pain ReliefDr. Tom’s #1 Brand
Dr. Hoy’s + arnica boost — for bruising, swelling, post-injury inflammation. Adds arnica’s anti-inflammatory power to the standard menthol formula.
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Dr. Hoy’s Natural Pain Relief Roll-OnDr. Tom’s #1 Brand
Same Dr. Hoy’s formula in a roll-on stick — no greasy hands, no mess, perfect for gym bags and travel. TSA-friendly.
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Dr. Hoy’s Pain Relief Gel — 3-Pack BundleDr. Tom’s #1 Brand
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Top 10 Premade Orthotics — Dr. Tom’s Picks (2026)
Dr. Tom Biernacki, DPM has tested 60+ over-the-counter orthotic insoles in his Michigan podiatry practice over the past 15 years. Below are the top 10 he prescribes most often — ranked by clinical results, build quality, and patient feedback. PowerStep + CURREX brands are Dr. Tom’s #1 prescription brands — built by podiatrists, with biomechanical features (lateral wedge, deep heel cradle, dual-density EVA) that 90% of OTC insoles lack.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
The most prescribed OTC orthotic in podiatry. Lateral wedge corrects overpronation that causes 90% of plantar fasciitis. Deep heel cradle stabilizes the ankle.
- Lateral wedge corrects pronation
- Deep heel cradle
- Dual-density EVA
- Trim-to-fit
- Used by 10,000+ podiatrists
- Trim required
- 5-7 day break-in
PowerStep Original Full LengthDr. Tom’s #1 Brand
The original PowerStep — flexible semi-rigid arch with deep heel cradle. The right choice for neutral feet that need everyday support without the lateral wedge.
- Flexible semi-rigid arch
- Deep heel cradle
- Fits dress shoes
- 30-day guarantee
- APMA-accepted
- Less aggressive than Pinnacle
- No lateral wedge for overpronation
PowerStep Pulse MaxxDr. Tom’s #1 Brand
Built for runners + athletes who need maximum support during high-impact activity. Engineered for forefoot strike + lateral motion.
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CURREX RunProDr. Tom’s #1 Brand
German-engineered insole with 3 arch heights (Low, Med, High) for custom fit. Carbon-reinforced heel + dynamic forefoot.
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CURREX EdgeProDr. Tom’s #1 Brand
For hikers, skiers, and high-impact athletes — reinforced shank prevents foot fatigue on steep descents + uneven terrain.
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CURREX SupportSTPDr. Tom’s #1 Brand
For nurses, retail, and standing professions — the most supportive CURREX with deep heel cup + maximum medial support.
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Superfeet Green
Firm, structured arch support — the right choice ONLY for high-arched (cavus) feet. Wrong choice for flat feet.
- Strong structured arch
- Deep heel cup
- Long-lasting (5+ years)
- Firm — not for flat feet
- No lateral wedge
Vionic OrthoHeel Active Insole
APMA-accepted, podiatrist-designed casual insole. Best for adding mild arch support to dress shoes + walking shoes.
- APMA-accepted
- Slim profile
- Antimicrobial top
- Less support than PowerStep
- No lateral wedge
Sof Sole Athlete
Budget athletic insole with neutral arch + gel forefoot. Decent value if you need a quick replacement.
- Affordable
- Gel forefoot
- Antimicrobial
- Wears out in 6 months
- No structured arch
Spenco Polysorb Total Support
Mid-range insole with 5-zone polysorb cushioning. Decent support for standing professions.
- 5-zone cushioning
- Trim-to-fit
- Mid-price point
- Less stable than PowerStep
- No lateral wedge
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
CURREX RunProDr. Tom’s #1 Brand
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Biofreeze
- Pricier than Biofreeze
- Strong menthol scent at first
When to See a Podiatrist for This Type of Pain
If your pain has lasted longer than 3-4 weeks despite home treatment, is interfering with daily activities, or includes redness, swelling, or warmth, it’s time to schedule an evaluation. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki and his team specialize in same-day diagnosis and conservative treatment plans tailored to your activity level and goals. Most patients are walking pain-free within 4-6 weeks of starting our protocol.
Red flags that warrant immediate care: sharp pain after a fall, inability to bear weight, visible deformity, numbness or tingling, fever with foot pain, or any open wound on a diabetic foot. Don’t wait — early treatment dramatically improves outcomes and prevents chronic complications.
Visit Balance Foot & Ankle — Same-Day Appointments Available
Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Hills. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.
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.
Is surgery required?
Most patients resolve with non-surgical care. Surgery is reserved for refractory cases or structural deformity.
What is Metatarsalgia?
Metatarsalgia is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of metatarsalgia include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of metatarsalgia respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from metatarsalgia varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
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Same-week appointments available in Howell and Bloomfield Hills, Michigan.
Book Your VisitOur podiatrists treat the underlying cause, not just the symptom. Same-week appointments at our Howell and Bloomfield Hills, Michigan offices.
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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.