Keeping Active with Freiberg’s

posted in: Fitness | 18

Keeping Active with Freiberg’s

Australia Zoo, MixHart 17

I’ve  decided to post about my recent sports injury to prevent other athletes from doing unnecessary damage to their feet and also, to clear up any misconceptions about why I haven’t been able to run and do other high impact sports for the past year.

My “wild and free” sporting life changed last May.

I felt an extreme sharp “snapping”pain in my right foot while walking with daughter, after her Kung Fu lesson. The pain was so intense that I took off my sandal and hobbled barefoot along the sidewalk to the car.

As walking was very painful, I made an appointment with my general physician. He informed me the x-ray looked okay so there was nothing to be done–he could not help me. The pain continued. Believing that there was nothing to be done, I’d rest my foot for a week and then try to do my beloved sports again. I could no longer dance or run but I could walk my dogs and hike, despite the pain.

Last fall, I spent many hours a day, five days a week, on my feet, teaching writing at a local college. Each day, after work, my right foot was in extreme pain and my toes numb. I had to take off my shoe and drive home barefoot.

I returned to my doctor and begged to be referred to a sports medicine specialist. After a six month wait, I finally got an appointment. The specialist palpated the foot, and told me that x-rays are often inconclusive when dealing with many foot fractures. He advised me that I was to completely immobilize and rest the foot for 3 months: I had to wear a boot-cast and crutches for twelve weeks (I’d just purchased a season pass for alpine skiing–thankfully, the ski resort put the money towards my next year’s pass purchase).

I hobbled all over campus on crutches and finished the term without missing any classes. In retrospect, this was not a good decision for me to make, as walking all over campus on crutches, with a heavy backpack, proved to be very hard on my (good) left foot and my actions damaged my left ankle.

After twelve long weeks (I couldn’t even walk my dogs), the boot came off and I went on a vacation to Florida. As I walked along the beaches in bare feet, I soon realized that the foot was far from healed. The pain returned with a vengeance. By vacation’s end, I could barely walk on it. I returned to the sports medicine doctor and begged for an MRI.

I was advised that it may take up to a year or more to get an MRI; however, the universe was with me and the MRI technician students needed to practice foot MRIs and I was able to get an MRI almost immediately!

Great Barrier Reef, Mix Hart 17

The Bad

The MRI results were unexpected: I have a condition called Freiberg’s Infraction (also called Freiberg’s Disease). It is a rare disease that involves the metatarsal bone (most often the second) in the foot. Repeated sports trauma limited the blood flow to the bone and finally caused the bone to die and become necrotic. It is  most common in athletic teens (females), who have long, lean bones, specifically, long metatarsal bones. Repeated high-impact sports and also wearing high heels exasperates the problem.

I am lucky, I’ve most likely had this for a decade or more, but my body managed to self-heal until now. I believe intense, high impact dancing (sometimes, unfortunately, on cement and tile surfaces), and running on roads caused frequent, reoccurring trauma and finally my body could not self-heal, and the blood loss was too great; thus, the bone began to die.

I am disappointed in the medical system in my home city. I had to fight every step of the way to be taken seriously.

I am also disappointed in the FiveFinger barefoot runners that I wore for years to dance and run in. I believe these contributed to my developing Frieberg’s. I remember after running, I’d develop a round, marble-sized, blood-filled ball under my foot, behind my 2nd metatarsal (at least a few times a season). It would hurt to walk and would take about a week to heal. I assumed it was regular running ware and tare (even though none of my other running friends experienced this). Now,I realize it was a serious injury, with blood loss, in the metatarsal joint. I had no idea that running in Vibram’s FiveFinger runners was not protecting my feet from the extreme impact on my foot bones.

The diagnosis has felt devastating at times; I am a person whose livelihood is sports and being active. 

Kalamalka Lake, BC,Mix Hart 17

Where Do I Go From Here?

It’s been over a year since the first initial bone collapse. I live in Hoka runners (for all occasions) with a podiatrist designed insole.

I will never wear high heels again. I always hated wearing high heels and never understood how anyone could wear them for more than 20 minutes a day. However, many of my really ‘hip’ footwear have just enough of a heel to make them dangerous for my metatarsal and thus, I will have to give away at least a dozen expensive boots and shoes 🙁 My daughters will benefit from this shoe give away. #nohighheels

I hike and have attempted to dance (a few times). My foot hurts and I cannot dance properly–no jumping or hopping. I cannot go barefoot anymore, walking in sand is especially painful. I worry that my foot may never heal enough to return to walking barefoot in the sand, surfing, running and “real” dancing. However, it is a worry and not the truth; thus, I manage my foot pain daily and work on adding new activities until I am able to run again.

Snowshoeing Knox Mountain, Mix Hart 17

My advice to athletic women with long, slight bones is to be aware: recurring front foot pain and/or numbness when engaging in high impact sports or while wearing high heels could be the beginning of Freiberg’s.

The Good

There are a few good things that have come from this personal struggle:

I wanted to start swimming laps, but never found the time. Being unable to do many sports while in the boot, I took up lap swimming during our time living in Australia. We lived in downtown Brisbane in a high rise apartment with a swimming pool. Every morning, I went down to the outdoor pool and swam laps for half an hour. I am now the lap swimmer I longed to be.

In the winter, I love being outside, skiing through high alpine forests all day long. This past winter, I watched my family leave for the ski hill on weekends and I felt depressed. How would I survive the long winter without skiing? I’ve always wanted to snowshoe but couldn’t justify the time and money required to do it as my family chose alpine skiing as our main winter sport. Finding myself unable to ski, I thought perhaps the soft snow might be easier on my foot and so I took up snowshoeing. I adore walking through secluded forests in my new snowshoes.

I love being on the water. I wanted a paddle board for years but never purchased one. I decided that paddle boarding would be easier on my foot than surfing (which requires toe strength). I researched and bought a Paiwen: a lightweight SUP, designed exclusively for women. I am addicted to SUP now! After an early morning lake paddle, before I head to shore, I like to sit on my board and meditate for a few minutes–it is an amazing way to start the day.

18 Responses

  1. Debbie
    | Reply

    I hope you dont mind me contacting you? Since January I have had numerous xrays, ultrasound, and mri scans. The pain and swelling in my joint has been so bad have been unable to walk anywhere! Seen various Podiatrists who say the head of my metatasal joint is flattened and has necrosis. They have also suggested stress fracture. None of them seem to know what the problem is. On radiologyst suggested Freibergs. I have been in a hard boot now for 2 months, its ok while wearing it, but symptoms come back straight away when I take it off. feeling so depressed as I love walking and the weight has piled on!! Dont suppose you can suggest who in the medical profession I should see? Perhaps a “bone” specialist?

    • mixhart
      | Reply

      Hi Debbie, Try an orthopaedic surgeon. Though, in my experience, I had to wear the boot for at least six months and then wear Hoka running shoes after that, at all times. Healing is super slow and I would suggest trying the new laser treatments on the area. I still must be extremely careful in what I do or the extreme pain will return. It is a condition that one has to live with and gradually test adding new activities. Do not get discouraged though, it heals very slowly and you may have to “baby” it indefinitely. I still have to “baby”my foot. Though, I am just now adding trail running back into my life and hope to compete in the near future. I have been receiving many notes from other women with Friebergs. Thus, I may start an online support group. If I do, I’ll let you know!

    • Debbie
      | Reply

      Hello, i have had severe pain & swelling in my left foot for 8 months, after having x-rays ( inconclusive ) , nuclear bone scan ( inconclusive ) , finally had an MRI end of July 2018. Dr called & said I have Freibergs disease, I have been in a walking cast 3 times this year, thinking stress fractures etc. the last being 3 months & counting as its still on, I am so frustrated, as soon as I walk on my foot within 2 minutes I get severe burning, numbness & pain, after 30 minutes my foot starts to swell up. I am glad I am not alone, i started thinking maybe this was in m head & didn’t think anybody would take me seriously about the issue with my foot. I have read so many of your comments on this web site & it is every bit the same as I am going through. thank you ladies for posting this information, I do hope that you all get the issues resolved, i sure hope i get some relief soon too!

      • mixhart
        | Reply

        Hi Debbie,
        It take more time than you’d hope but with a lot of rest (from even walking), super-padded shoes and time (2+y), your foot will improve (personal experience). It’s easy to get discouraged as healing seems to be one step forward, 2 steps back. 2 1/2 years since I first hurt my foot and I am feeling so much better–I can walk bare foot in the sand without pain! Though, I will always baby that foot so it remains functional (I will never wear high heels again & walk bare foot for only short journeys). Things will improve–M

  2. Helen
    | Reply

    Hi I have just read your blog on friebergs disease and it was almost like reading my own story. Same excruciating foot pain with no results from an x ray apart from go home and rest it for a week!! I was a runner but got to the point where after even a short run my foot would throb! After numerous trips to podatrist after being told I have inflexible toes!!!! Finally moved state ( I live in Australia) had another x ray and was told friebergs infraction!! Trying podiatrist inserts no heels no running but cycling is ok!! Theres not much info out there and after reading your reply to someone else I think a suppory group would be great as no one really understands what we go thro on a daily basis. Thanks for taking the time to read this.

  3. mixhart
    | Reply

    Hi Helen,
    Freiberg’s is very much a disease one suffers with alone. Unless one is a professional athlete, making a huge income using the feet, medical professionals are not too concerned. However, as this is a condition that takes a long time to heal, and completely limits mobility. I agree, a support group is needed. I’ll send out a notice on this page if I start one and also, let me know if you decide to start one.

  4. Kym Ortenburg
    | Reply

    Hello – I’ve just been diagnosed with Freiberg’s last week ( and neuromas of the 2nd and 3rd metatarsals for which I had some very painful cortisone injections – but they have reduced the swelling). It’s painful and debilitating and I’m not supposed to put any weight on it for at least 4 weeks! Seeing an orthopedic surgeon on 30 Nov.
    I also suspect that I’ve had it a very long time (I’m 55, did ballet, netball and a lot of walking and hiking) and went through periods of pain and recovery – at the time I just thought it was a very sore foot from all the walking I do for my work! I think a support group would be fabulous… I’m contemplating the clearout of my beloved shoe wardrobe and it’s a bit depressing. Good luck everyone! Hope you’re pain free soon.

    • mixhart
      | Reply

      Dear Kym,

      Yes, I too found a few of the cortisone injections left my foot in agony for 24 afterward, but then the foot felt better than it had for awhile. It is a long, slow recovery but I can assure you, things will get better. I still have pain on my 2nd metatarsal after hard-core dancing in dance-style jazz sneakers, but not enough to stop me dancing. Though, I avoid ballet jumps for now. Oddly,even after 2 years, the skin above the area of my ‘Freibergs’ toe joint is flushed bright pink, while the rest of the foot is a natural colour?! Feel free to keep in touch. …still working on the support group idea! Best shoes I’ve bought to date are the ‘Teva platform universal’ sandals from last summer’s collection. The most comfortable shoe for my ‘Freibergs’ foot ever! Like walking on clouds…

  5. Paul
    | Reply

    Thanks for sharing your story.

    I am one of the rare males who suffers from this condition (I think the ratio is 5:1 female to male.) I am 22 years old and was diagnosed with freibergs at age 20. I am very much into sports and physical fitness and this makes it very difficult to pursue what I love doing. I always wear thick insole shoes along with custom orthotics with metatarsal pads on them, which help somewhat with pain… but not completely.

    I was just wondering what you meant about the new laser treatments for freibergs disease, as you eluded to in your comment earlier? I have heard nothing about such a treatment option in all of my readings on the condition. I was also wondering if you would recommend one of the surgical intervention options.

    Thank you,

    • mixhart
      | Reply

      Hi Paul,

      The laser I was referring to is Class IV K-Laser Therapy. You will need to enquire around to various physical therapists/other health professionals to see who does this type of therapy near you. The laser speeds up the healing process. I recommend at least 6 treatments to maximize healing results. If you can afford it, I’d even get more…anything to speed the healing and bone regeneration. I have not considered surgery as I have very little bone damage. Also, it has been 2 and 1/2 years since the first serious mobility-stopping incident (that caused me to seek treatment for this condition) and now, finally, I can say, that my foot feels so much better and I am trail running again. My foot is not perfect but I believe that I can have a very full, athletic life again. Though, it takes time, and wearing spongy-soled shoes exclusively! However, if you have a lot of bone loss, you may have a longer recovery. Though, you have youth on your side, thus, whatever shape your foot is in, your healing process will be faster than anyone diagnosed in middle age.
      Re. surgery options–I have read many mixed reviews on the success/failure rates of metatrarsal surgery. Thus, I would not rush into it, unless you’ve run out of other options and/or you have serious bone degeneration. I hope this helps. Take care, and keep hopeful…I am sure you will be able to do your athletic pursuits again.

  6. mixhart
    | Reply

    ***An update: Just wanted to mention that I experienced marble-sized blood filled bruises on the bottom of my foot once or twice a year after running in 5-toe runners, for at least 1/2 a decade prior to being diagnosed with Freiberg’s. At the time, I thought it was normal running ware and tare. It was obviously that kind of injury and blood loss that exasperated Freiberg’s. If you have marble-sized blood bruises on the bottom of your foot–stop doing whatever sport is causing them. I sure wish I’d known that then!

  7. mixhart
    | Reply

    New facebook support group for Freiberg’s:

  8. Trish
    | Reply

    Hello Mixhart,
    I was diagnosed with Freiberg’s disease yesterday! My foot swelled up at the end of August and I was in pain, my GP sent me for a cat scan and the results came back that I had an extra bone in my foot. Saw an orthopaedic surgeon yesterday .. thinking that he would meet and organise to remove the extra bone! He told me about Freiberg and the position with my foot! The cartilege between the bones on my index toe is completely gone, my bone is not as normal, nice and round, rubbing off the other bone, hence the pain!! He says the state of it is beyond repair. I can, in years to come, when I cannot walk possibly, opt for surgery …. using existing tendon to wrap around the bone and use a pin to keep in place! He recommended a podiatrist, but as I only wear shoes a handful of times during the year I said it wasn’t an option. My footwear of choice is Birkenstock .. I have found my feet got very warm and burn if I wear shoes so I have tried to stick to Birks! I am Irish living in Australia so being honest it isn’t a big thing for me 😉 Other option is a steroid injection to ease the inflammation.. He advises that there are different stages of this disease and I am at the end of it where there is no cartilege left and therefore nothing that can be done in the immediate future, apart from the injection. Like everybody else on here, I am active, and have always been, and continuing to be! I am interested to read all your stories and I have asked to join the FB page! My husband has come across a podiatrist recommended pad/bar Metatarsal Bar PPT Cushions on which can be inserted in my Birks so as a starting point for me, I am going to order and give a go!!! There is a very good youtube clip Jeffrey A Oster who explains exactly about his particular product .. I found it helpful maybe somebody else will too! Thank you for sharing y our stories, it is good to know, while this rare, we are not alone!

    • mixhart
      | Reply

      Thank you for your story, Trish. Happy Birks are working for you. Hope you have experienced some improvement in the last year. Sorry it took me a while to respond!

  9. mara
    | Reply

    Hi all! Just ran across this blog. I have Freiberg’s disease, got diagnosed about 10 years ago (I am now 38). I figured I would share my experience, so that you can all feel that there is hope, and that you can eventually be pain free, and return to the activities you love (with some precautions). I used to be a runner, and I think probably all that running on pretty lean bone structure and very long metatarsals precipitated the condition. I do remember spending a few months in a LOT of pain. I couldn’t walk at all, and had to use crutches. But eventually making sure I wore rigid sole shoes (I lived in my Merrell hiking boots for about a year), and avoiding high impact activities, eased my pain. I used a special insole with a metatarsal cushion for a while, but realized eventually that it actually contributed to inflammation because it also compressed my forefoot against the top of the shoe (taping my toe to the adjacent one also seemed to cause more pain). I mention it because sometimes those recommendations don’t work for everyone, and you just have to figure out what feels better for you (using pain as an indicator). In my case, the key was to wear shoes that had good cushioning, and which didn’t flex too easily at the metatarsal joint. I was really scared of returning to activity, because I feared relapsing into very bad pain or causing more damage, and I avoided most running and jumping for a long time (and I am a very active person so it was frustrating). But I did a lot of biking ,swimming, and in a way, diversifying my physical activity has been more beneficial to overall fitness. I gradually returned to doing some more impact activities–I won’t go on runs longer than 5 miles, but I can jump rope, dance, and run now pain free, most of the time (I have even been practicing moonwalking, and other dancing footwork involving standing on the toes which was completely unthinkable when I first had the diagnosis), and have recently tried cross-fit and weightlifting with no issues. I believe when I was diagnosed, I was already an advanced stage of Freibergs, but I imagine the “damage” is self-limited, because it has been several years, and although I’ll occasionally have pain (usually when I walk on very soft soled shoes for a very long time, OR do a lot of jumping), I just ice it or rest the foot for a day, and it goes away. The doctors I’ve seen all say that there are conflicting studies on whether or not surgery is actually helpful (unless you have bone fragments floating around the joint or unrelenting pain, I think conservative therapies are best). I’m not a doctor, so can only speak from my personal experience, but I do believe trying out different activities, being very mindful of pain, but without fear, aids in recovery. Strengthening the muscles of the foot will also help take some of the load off the joint, it’s a bit of trial and error, but don’t feel like this diagnosis means you can’t do the activities you love. The body always adapts. Just have patience and my advice is to also be aware of your other foot, because when you are in pain, your other foot will compensate and take most of the load, and this can later contribute to other issues (in my case, I developed some hip pain on my good side, but have successfully treated that as well). Anyway, happy to share more details if anyone is interested.

  10. mixhart
    | Reply

    Hi Mara,

    I’m happy you have been able to successfully continue your activities. I’ve experienced similar pain with jumping and long walks in regular shoes. I was hopeful that the pain would just one day disappear but I realize it requires constant management. Sadly, I overdid the activities recently; trail running 4x/week plus hi-impact dancing for 2h at a dance party one evening and the pain has returned with a vengeance Even after a few years with the condition and returning to many of my sports, I am still learning my limits.

    • mixhart
      | Reply

      Thank you!

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