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The forefoot consists of five metatarsal bones that originate in the midfoot and descend at an angle to meet the toes. Each of the five metatarsal bones terminate at the metatarsal phalangeal joints (mpj's). The plantar, or bottom aspect of the mpj is often called the ball of the foot. Due to the amount of load bearing applied to the forefoot in walking and running, the forefoot is prone to a number of different injuries.

The distal portion of the forefoot consists of the 1st mpj and the lesser mpj's (2-5). The great toe joint (1st mpj) is a bit unique in that the anatomy of the great toe joint is a bit different than that of the lesser mpj's. To a degree, the lesser mpj's act independently of the 1st mpj. Therefore , any discussion of forefoot conditions should be broken into those problems specific to the 1st mpj and those problems specific to the lesser mpj's (2-5).

The following is a list of common forefoot conditions. To find more information about these conditions, follow the highlighted link.

Forefoot conditions specific to the 1st mpj.

    1. Bunion
    2. Gout
    3. Hallux limitus
    4. Hallux rigidus
    5. Pseudogout
    6. Sesamoiditis and sesamoid fractures
    7. Turf toe

Forefoot conditions specific to the lesser mpj's (2-5).

    1. Bursitis
    2. Capsulitis
    3. Freiberg's Infraction
    4. Metatarsalgia
    5. Morton's Neuroma
    6. Metatarsal stress fractures

Nomenclature:

Metatarsal - there are five metatarsal bones in each foot. Each metatarsal bone runs from the arch to the ball of the foot. When load is applied to the forefoot, the metatarsal bone carries that load.

Itis - the suffix applied to any inflammatory condition.

Capsule - the soft tissue layer that surrounds any joint. The inner lining of the capsule is called synovium and produced synovial fluid, the fluid that lubricates the joint.

MPJ (metatarsal phalangeal joint) - the joint between the metatarsal and the toe bone (phalanx, pl., phalange, singl.)

Bursa - a small sack that forms as the result of chronic, repetitive inflammation.

Anatomy:

The forefoot consists of five metatarsal bones that originate in the midfoot and descend at an angle to the forefoot. Each of the five metatarsal bones terminate at the metatarsal phalangeal joint (ball of the foot). A primary (long) and secondary (short) tendon traverses each of the metatarsal phalangeal joints to pull the toes up and down. Numerous nerves and blood vessels supply the forefoot with sensation and blood supply.

The great toe joint is unique in that it has a pair of bones on plantar (bottom) aspect of the joint called sesamoid bones. The sesamoid bones are the shape an size of a kidney bean. The sesamoid bones can be compared to the knee cap (patella) in that the sesamoids are attached to a muscle on their proximal aspect. When that muscle contracts, it pulls the sesamoids under the joint creating a mechanical advantage and increased range of motion of the joint.

Biomechanics:

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Symptoms:

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Differential Diagnosis:

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Products Recommended for Forefoot Pain:

See Also:

References:

This article was written by Jeffrey A. Oster, DPM and last updated 1-15-09.

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