Metatarsal Bones
Ossa Metatarsalia
location_on Forefoot, between the tarsal bones and the toes
The five metatarsal bones form the forefoot skeleton, numbered 1 to 5 from the great toe to the little toe. Each has a base (proximal), shaft, and head (distal). The first metatarsal is the shortest and thickest, bearing the most weight during push-off in gait. The fifth metatarsal has a prominent styloid process at its base, a frequent avulsion fracture site. Metatarsal stress fractures (march fractures) are among the most common overuse injuries.
Key Anatomical Features
- Five bones numbered 1 (great toe) to 5 (little toe), forming the forefoot
- First metatarsal is the shortest but thickest, bearing the most weight at toe-off
- Fifth metatarsal styloid process (tuberosity) is the insertion of the peroneus brevis
- Heads form the ball of the foot and bear weight during the push-off phase of gait
- Second and third metatarsals are the longest and most commonly affected by stress fractures
- Bases articulate with the cuneiforms (1-3) and cuboid (4-5) at the Lisfranc joint
Muscle Attachments
| Muscle | Attachment | Action |
|---|---|---|
| Dorsal interossei (4) | Adjacent metatarsal shafts | Abduct the toes away from the second toe axis |
| Plantar interossei (3) | Medial sides of metatarsals 3-5 | Adduct the toes toward the second toe axis |
| Peroneus brevis | Styloid process of fifth metatarsal | Everts the foot |
| Peroneus tertius | Dorsal surface of fifth metatarsal base | Dorsiflexes and everts the foot |
| Peroneus longus | Plantar base of first metatarsal | Plantarflexes and everts the foot |
| Tibialis anterior | Medial base of first metatarsal | Dorsiflexes and inverts the foot |
Joints and Articulations
| Joint | Type | Connects to |
|---|---|---|
| Tarsometatarsal (Lisfranc) joints | Synovial plane | Cuneiforms (1-3) and cuboid (4-5) |
| Metatarsophalangeal (MTP) joints | Synovial condyloid | Proximal phalanges |
| Intermetatarsal joints | Synovial plane | Adjacent metatarsal bases |
Common Pathologies
Metatarsal stress fracture (march fracture)
The second and third metatarsal shafts are the most common sites. Called march fractures because they were first described in military recruits. May not be visible on initial X-rays for 2-3 weeks.
Fifth metatarsal base fracture (Jones vs. avulsion)
Avulsion fractures at the styloid process (peroneus brevis pull) are common and heal well. True Jones fractures occur at the metaphyseal-diaphyseal junction and are prone to nonunion due to poor blood supply.
Hallux valgus (bunion)
Medial deviation of the first metatarsal head with lateral deviation of the great toe at the MTP joint. The most common forefoot deformity, affecting 23% of adults.
Metatarsalgia
Pain under the metatarsal heads (ball of the foot), commonly from overloading of the second or third metatarsal heads due to first ray insufficiency or ill-fitting footwear.
Freiberg disease
Avascular necrosis of a metatarsal head, most commonly the second. Presents in adolescent females with forefoot pain and limited MTP joint motion.
Clinical Relevance
The Jones fracture (at the metaphyseal-diaphyseal junction of the fifth metatarsal) must be distinguished from the much more common avulsion fracture at the styloid process, as Jones fractures have a high nonunion rate (up to 30%) and often require surgical fixation. Metatarsal stress fractures may be invisible on radiographs for 2-3 weeks; MRI is the gold standard for early diagnosis. The first MTP joint is the most common site of gout in the body (podagra).
Development and Ossification
Each metatarsal ossifies from two centers: one for the shaft (8th-9th fetal week) and one epiphysis. Like the first metacarpal, the first metatarsal has its epiphysis at the base (proximal end), while metatarsals 2-5 have theirs at the head (distal end). Epiphyses appear between ages 3 and 4 and fuse between ages 14 and 18.
Did You Know?
- March fractures got their name from Prussian military physicians who described them in soldiers after long marches in the 1850s
- The first metatarsal bears about 40% of the body's weight during the push-off phase of walking
- Morton's toe (a second metatarsal longer than the first) is present in about 20% of the population and was considered a sign of beauty in ancient Greece
Scan this bone yourself
Download Osteo+ and identify the metatarsal bones instantly with your camera. Get all the details above and more from a single photo.