Freiberg’s disease

Freiberg’s disease is often also known as Köhler 2. It involves death of bone tissue in the metatarsal bones. This causes pain and difficulty walking, but also makes the foot more susceptible to bone fractures. Often it is a bone fracture that causes Freiberg’s disease to be discovered.

Freiberg’s disease

Köhler 2, as Freiberg’s disease is sometimes called. This disease mainly occurs during puberty and occurs more often in girls than in boys. This concerns bone loss in one of the metatarsal bones. In the photo these are indicated as numbers 8 to 12 (click on the photo to enlarge). Freiberg’s disease (Köhler 2) should not be confused with Köhler’s disease (Köhler 1). This concerns bone decay of the tarsal bones. The tarsal bones are the bones in the foot that form the ankle and heel. Köhler 1 and 2 are inextricably linked: both cases involve death of the bone tissue in the foot.


The cause of Freiberg’s disease is often unknown. It is thought that poor blood circulation could be a possible cause, disrupting the blood supply to the bone. This causes bone cells to die. In addition, excessive strain on the foot can also play a role. It is clear that the disease usually only starts after the age of 14 and is much more common in girls than in boys. The disease is most commonly seen in adolescents and young adults. However, it can also occur in the elderly. This often concerns athletes who put a lot of strain on the foot.

Symptoms: pain and limping

In Freiberg’s disease, pain is felt in the foot. Not only during load, but also during rest. The pain complaints can vary. This way they can disappear for a while and return later. The pain is mainly felt at the bottom of the head of the affected metatarsal bone. Pressure pain may occur. Pressure pain is pain that is felt when pressing on the affected area. The disease is often accompanied by swelling of the foot. Freedom of movement can be greatly reduced. Later it can get so bad that walking is barely possible. As a result of the disease, osteoporosis occurs: a decrease in the strength of the bones. This makes people more susceptible to bone fractures. Dropping something on your feet can lead to a broken bone more quickly. In adolescents and young adults, the disease is initially easy to recognize because they start to relieve the painful foot. They walk with a limp/lame and alternately complain of foot pain. A broken bone in the foot is often the cause of a visit to a doctor. Many adolescents and young adults are not so inclined to go to a doctor with foot pain. Especially when the pain complaints vary greatly and it is not clear when they occur.

Treatment and recovery

Köhler 1 usually heals on its own, with Freiberg’s disease this is usually not always the case. This makes the overall prognosis look worse. Treatment is initially not aimed at healing but at eliminating the pain complaints. The orthopedist will often try arch supports or adapted shoes. Custom shoes usually consist of a shoe with a slightly raised heel. Sometimes this helps, but sometimes not. The doctor can apply a plaster cast (walking cast) to relieve the foot. This is done for several weeks and in the acute phase when most pain complaints occur. In a large number of patients it helps to stretch the Achilles tendon through stretching exercises. The physiotherapist can help with this.
Sometimes the metatarsal head can become deformed. Then an operation is necessary. This may differ depending on the stage of the disease. The disease has five stages. Only in the final stages are the symptoms so clear that it can be determined with certainty that it is Freiberg’s disease. An incorrect diagnosis is sometimes made in earlier stages.

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