Your metatarsal bones are the long bones that link your ankle to your toes. Between the heads of the metatarsal bones, and the bottoms of the proximal phalanges (your toe bones), are the metatarsophalangeal joints. In other words, metatarsophalangeal joints connect your toe bones to your foot bones. These joints are surrounded by a thin joint capsule and have ligaments that support them. There are a number of health conditions that affect the metatarsophalangeal joints, also referred to as MTP joints, some of which are reviewed below.

Metatarsalgia

Metatarsalgia is actually used to describe any pain in the ball of the foot; that’s the soft, padded part on the bottom of your foot that overlies the metatarsal bones. Even so, the most common source of pain in this area is the MTP joint.

 Bunion

A bunion is a bony bump that forms on the outside edge of the first MTP joint. As a result of a bunion formation, a condition called hallux valgus may develop, which is when the big toe deviates or points towards the other toes. As the first toe pushes on the second toe, a hammer toe may result.

A common cause of bunion formation with a hammer toe is wearing improper shoes; for example, high heels or shoes that fit too tightly or are pointed. Additionally, you may have heard the term bunionette, which is when a bunion forms on the little toe or fifth MTP joint.

Arthritis

With the inflammatory condition, rheumatoid arthritis, pain in the MTP joint may occur when standing or walking. Morning stiffness in the MTP joint can also be an early sign of rheumatoid arthritis. Inflammation of the joint in this disease can also lead to hammer toe deformities.

Osteoarthritis, a non-inflammatory form of arthritis, may also occur in the big toe MTP joint. With foot osteoarthritis, the cartilage of the joint wears down, and this can create pain and difficulties with walking. Gout is another form of arthritis that may affect the foot, especially the first MTP. Symptoms of a gout attack include sudden, severe pain, redness, and warmth of the big toe.

Hammer Toe

A hammer toe is a misalignment of the MTP joint, often of the second toe. There are multiple potential causes for a hammer toe. For instance, a hammer toe can develop after a bunion forms, which causes the big toe to shift or angle towards the second toe.

A hammer toe can also occur in rheumatoid arthritis when fat tissue in the ball of the foot is pushed forward under the toes. A traumatic injury to the toe can also cause a hammer toe, while some people are simply born with hammer toes, a genetic factor.

Finally, it’s important to note that further problems can develop, as a result of a hammer toe. These include corns, and reactive adventitial bursas (fluid-filled sacs), that form when fatty tissue in the foot is exposed to high pressure or friction.

Treating Problems of the MTP Joints

In order to manage conditions of the MTP joint, your doctor (for example, an orthopedic surgeon who specialises in treating the foot, or a podiatrist), will consider either surgery or non-surgical strategies.

Non-surgical Strategies

Most MTP joint-related problems are managed non-surgically. For example, in the case of a bunion (a common MTP problem), a doctor will often recommend that the person wear proper shoes, even custom orthotics (special shoe inserts made for your feet). For bunions, a shoe with a wide toe box, and one that is soft and stretchy can be helpful. Bunion pads can also protect the bunion from rubbing.

Orthotics can also help manage other MTP problems like metatarsalgia. Wide shoes or pads under the bones of the forefoot can ease discomfort. Other non-surgical approaches include using ice or taking anti-inflammatory medications to soothe pain and reduce swelling.

Surgical Strategies

There are a number of different surgical procedures to address your specific MTP issue. Even so, surgery is usually considered only when non-surgical strategies don’t work. First procedure is called first MTP joint fusion, and entails fusing the bones of the big toe and first metatarsal together permanently. It may be performed in cases of arthritis, where the joint cartilage has been worn away, and the resulting pain is not relieved by conservative or nonsurgical methods. First MTP joint fusion is often performed as a day surgery, but recovery can last six months. Metal screws and, often, a metal plate are used to stabilise the joint.

Another procedure, called the first MTP joint replacement, is done in cases of arthritis, to relieve pain that doesn’t resolve with conservative treatment. The big toe joint is removed, and implants are used to replace it. These may be made of metal or plastic. It differs from fusion in that the implant mimics the action of the original joint.

Your feet mirror your general health . . . cherish them!