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Metatarsophalangeal Joint

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Introduction

  • The anatomy of the plantar aspect of the 1st MTP joint is illustrated and labeled[1]
    The anatomy of the plantar aspect of the 1st MTP joint is illustrated and labeled[1]
Anatomy drawing of the 1st MTP joint-dorsal view. The 1st metatarsal was removed to permit the visualization of all anatomical structures of the joint[2]
Schematic illustration of the anatomy of the MTP joints of the lesser toes. (a) Sagittal view. (b) Coronal view. 1, plantar plate; 2, two strong bands of the plantar fascia merge with the plantar plate; 3, deep intermetatarsal ligaments; 4, accessory collateral ligaments; 5, proper collateral ligaments; 6, extensor hood; 7, extensor digitorum brevis tendon; 8, extensor digitorum longus tendon; 9, flexor digitorum longus tendon; 10, flexor digitorum brevis tendon; 11, flexor tendons tunnel; 12, lumbrical tendon; 13, interosseous muscle; 14, interdigital neurovascular bundle; 15, intermetatarsal bursae.[3]
Xray of the foot labeled[4]
First metatarsophalangeal joint of the big toe. The image shows enlargement, with associated erythema, of the first metatarsophalangeal joint most consistent with Gout[5]
Nerves adjacent to arthroscopy portals and at greatest risk of iatrogenic injury during establishment of portals. Portals are confirmed with a needle and insufflation before incision.[6]
Schematic model of the force amplification mechanism of the toe flexors.[7]

Names

  • MTP joints
  • Toe joints
  • Metatarsal-phalangeal joints
  • Forefoot joints
  • Ball of foot joints
  • Metatarsophalangeal articulations
  • Metatarsal head joints
  • Phalangeal base joints
  • First MTP joint (for great toe specifically)
  • Digital joints of the foot

General

  • Synovial joints located between the heads of the metatarsal bones and the bases of the proximal phalanges of the toes[8]
  • Each joint is stabilized by a fibrous capsule, collateral ligaments, and a plantar plate
  • The first MTP joint has additional sesamoid bones embedded in its plantar aspect

Function

  • Joints allow flexion, extension, and limited abduction/adduction
  • Contribute to the push-off phase of gait and overall forefoot stability

1st Metatarsophalangeal Joint

General

  • Hinged ball and socket articulation
  • Formed between the first metatarsal and its corresponding proximal phalanx[9]
  • Because of the shallow concavity of the base of the proximal phalanx, this articulation is relatively unstable
  • Stabilized by 9 ligaments, 3 tendons and 2 sesamoid bones[10]

Tendon Attachments

Hallux Sesamoids[11]

  • Articulate with a facet on the plantar surface of the first metatarsal head
  • Add stability to the joint
  • Protects the tendons in which they are housed
  • Increase the mechanical advantage of the FHB to facilitate load distribution, act as a shock absorber
  • Normal range of motion displaces the sesamoids relative to the metatarsal head

Ligaments[12]

  • 2 collateral ligaments which stabilize the joint during cutting
  • 2 plantar ligaments
  • Sometimes an intraarticular meniscus that further enhances stability

Plantar Plate[13]

  • Formed by the plantar ligaments, thickened plantar capsule and tendons of the FHB
  • Orignates from the head of the metatarsal at the distal portion of the sesamoids
  • Inserts to the plantar base of the proximal phalanx.

Range of Motion

  • Dorsiflexion: approximately 50° of dorsiflexion
  • Plantarflexion: 30° of plantarflexion

Weight Bearing[14]

  • Normal gait: sustain 40% to 60% of body weight
  • Walking: 80% of body weight during the toe-off phase of normal
  • This force increases 2x to 8x body weight when running and jumping[15]

Vascular Supply

  • First dorsal metatarsal artery
  • First plantar metatarsal artery
  • Branches of the medial plantar artery

Innervation

2nd to 5th MTP Joints

General

  • Condyloid joints
  • Rounded head of the metatarsal articulates with the shallow cavity of the proximal phalanx
  • Enclosed by a fibrous capsule
  • Reinforces by collateral ligaments and a plantar plate

Intrinsic Muscles

Clinical Significance

1st MTPJ

See Also

References

  1. ↑ Case courtesy of Matt Skalski, Radiopaedia.org, rID: 45171
  2. ↑ Nery, Caio, et al. "First MTP joint instability—expanding the concept of “turf-toe” injuries." Foot and Ankle Surgery 26.1 (2020): 47-53.
  3. ↑ Nery, Caio, Hilary Umans, and Daniel Baumfeld. "Etiology, clinical assessment, and surgical repair of plantar plate tears." Seminars in musculoskeletal radiology. Vol. 20. No. 02. Thieme Medical Publishers, 2016.
  4. ↑ Image courtesy of www.imaios.com/en
  5. ↑ Light, Jonathan, Laurie L. Wellman, and Richard M. Conran. "Educational Case: Gout." Academic Pathology 10.1 (2023): 100065.
  6. ↑ Sherman, Thomas I., et al. "First metatarsophalangeal joint arthroscopy for osteochondral lesions." Arthroscopy Techniques 5.3 (2016): e513-e518.
  7. ↑ Yamauchi, Junichiro, and Keiji Koyama. "The mechanical role of the metatarsophalangeal joint in human jumping." Plos one 17.5 (2022): e0268634.
  8. ↑ Drago, Sebastián, et al. "Assessment and management of atraumatic first metatarsophalangeal joint pain." JAAOS-Journal of the American Academy of Orthopaedic Surgeons 31.14 (2023): 708-716.
  9. ↑ York PJ, Wydra FB, Hunt KJ. Injuries to the great toe. Curr Rev Musculoskelet Med. 2017;10:104-112. doi:10.1007/s12178-017- 9390-y
  10. ↑ Hong CC, Pearce CJ, Ballal MS, Calder JD. Management of sports injuries of the foot and ankle: an update. Bone Joint J. 2016;98-B:1299-1311. doi:10.1302/0301- 620X.98B10.37896
  11. ↑ Kadakia AR, Molloy A. Current concepts review: traumatic disorders of the first metatarsophalangeal joint and sesamoid complex. Foot Ankle Int. 2011;32:834-839. doi:10.3113/FAI.2011.0834
  12. ↑ Childs SG. The pathogenesis and biomechanics of turf toe. Orthop Nurs. 2006;25:276-280. doi:10.1097/00006416- 200607000-00012
  13. ↑ Hong CC, Pearce CJ, Ballal MS, Calder JD. Management of sports injuries of the foot and ankle: an update. Bone Joint J. 2016;98-B:1299-1311. doi:10.1302/0301- 620X.98B10.37896
  14. ↑ Stokes IA, Hutton WC, Stott JR, Lowe LW. Forces under the hallux valgus foot before and after surgery. Clin Orthop Relat Res. 1979;(142):64-72.
  15. ↑ Nigg BM, Yeadon MR. Biomechanical aspects of playing surfaces. J Sports Sci. 1987;5:117-145. doi:10.1080/02640418708729771
Created by:
John Kiel on 27 January 2022 16:30:55
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Last edited:
5 March 2026 20:45:00
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