There are several causes for discomfort within the ball of the foot. A less common diagnosis could be a disorder called Freiberg’s disease or infarction. This is a disorder in which the head of a metatarsal bone that is at the base of the toes in the front foot results in being weakened and has small bone injuries. Freiberg’s disease most commonly occurs in the 2nd and 3rd metatarsal heads, although all metatarsals may be impacted. It is believed to be caused by repetitive overload to the metatarsals heads that create a local deficit of blood circulation to the region. These metatarsal heads then become weakened and has micro fractures. Freiberg’s disease typically happens in young sports athletes over about the age of 12, and much more frequently has an effect on younger girls greater than young boys. The actual microtrauma appears to result from overloads and particularly in sports activities which entail lots of sprinting, bouncing or pivoting on the ball of the foot. Using non supporting or poorly cushioned footwear may give rise to increased strain over the metatarsal bones.

The common features include things like increasing pain and discomfort over the damaged metatarsal head. There is commonly a swelling and slight bruising about the involved area. The pain sensation could become worse with elevated weight bearing exercises. Generally you will find a reduced ability to move at the impacted toe joint together with pain and discomfort found on motion with the affected toe joint. Limping to offloading the damaged area is furthermore frequent. The diagnosis of Freibergs disease is made by a medical practitioner and it is according to a number of features like a full clinical evaluation which will incorporate a structural evaluation and also a gait investigation. There will be an assessment of the complete pain and discomfort background and medical history evaluation to rule out virtually any other causes for the signs or symptoms. The joint range of flexibility will be looked at, and a physical palpation of the bone will be done. The definitive examination will likely be made by x-ray and this frequently shows a compression to the metatarsal bone, looking like a crushed egg shell with the most severe cases.

The management of Freibergs disease starts off with rest along with immobilisation with the foot for about 6 weeks. This can be needed in the early period of therapy for it to permit the minuscule fracture site to heal. The immobilisation is often carried out with a moon boot or perhaps cam walker given by a physician. Foot orthotics may well be used to decrease the painful signs and symptoms of Freiberg’s disease. The aim of the foot insoles is to achieve this through off loading the location and also with some re-aligning with the foot. They have to give support on the symptomatic metatarsal head and so are generally recommended following that early period of immobilization. A steel or even graphite insole may also regularly utilized to make the shoe stiffer. Because of this there's reduced flexion or bending of the shoe with the forefoot which lessens stress on the location. Non steroidal anti-inflammatory medicines for example ibuprofen can be used for pain relief and also to reduce inflammation. If this doesn't improve then a surgical restoration with the micro-fracture site may be required to solve the damaged tissues.