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Metatarsus – Anatomy, Function and Conditions

The metatarsus (midfoot) consists of five long bones in the foot located between the tarsal bones and the toes. It forms the bony foundation of the forefoot arch.

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The metatarsus (midfoot) consists of five long bones in the foot located between the tarsal bones and the toes. It forms the bony foundation of the forefoot arch.

What is the Metatarsus?

The metatarsus, commonly referred to as the midfoot, is an anatomical segment of the human foot. It is composed of five long bones known as the metatarsal bones (Os metatarsale I–V), which are situated between the tarsal bones (tarsus) proximally and the phalanges (toe bones) distally. The metatarsal bones are numbered from medial to lateral: the first metatarsal is located on the inner side (big toe ray), and the fifth on the outer side of the foot.

Anatomy and Structure

Each metatarsal bone is divided into three sections:

Base (Basis ossis metatarsi): The proximal end, which articulates with the tarsal bones.
Shaft (Corpus): The long, slender middle section of the bone.
Head (Caput): The distal end, which forms the metatarsophalangeal (MTP) joint with the proximal phalanx of each toe.

Together, the five metatarsal bones and the tarsal bones form the longitudinal arch and the transverse arch of the foot. This arch structure is essential for shock absorption and even weight distribution during walking and standing.

Function of the Metatarsus

The metatarsus serves several important functions in the human musculoskeletal system:

Weight distribution: During standing and walking, body weight is transferred to the ground primarily through the metatarsal heads (especially the first and fifth).
Push-off mechanics: The metatarsus acts as a lever during the push-off phase of the gait cycle.
Arch stabilization: The metatarsal bones contribute to the stability of both the longitudinal and transverse arches of the foot.
Movement transmission: The MTP joints allow flexion and extension of the toes.

Common Conditions of the Metatarsus

Metatarsalgia

Metatarsalgia refers to pain in the area of the metatarsal heads, commonly caused by overuse, a splayed foot (splay foot), or inappropriate footwear. The pain typically occurs during walking or standing and is localized to the ball of the foot.

Stress Fracture (March Fracture)

A stress fracture of the metatarsus, also known as a march fracture, results from repetitive mechanical loading without adequate recovery time. The second and third metatarsals are most commonly affected. Typical individuals at risk include runners, soldiers, and dancers.

Hallux Valgus

Hallux valgus is a common deformity in which the first metatarsal deviates inward while the big toe angles outward. This leads to a prominent bony bump at the first metatarsal head and can cause significant pain and difficulty with footwear.

Morton Neuroma

Morton neuroma is a painful thickening of the plantar nerve, most commonly occurring between the third and fourth metatarsal bones. It causes burning, shooting pain in the forefoot area, often worsened by tight shoes.

Splay Foot (Transverse Flatfoot)

In a splay foot, the transverse arch of the metatarsus is flattened, resulting in increased pressure on the metatarsal heads. This leads to pain, callus formation, and can contribute to metatarsalgia.

Diagnosis of Metatarsal Conditions

Conditions affecting the metatarsus are diagnosed using:

Clinical examination: Inspection, palpation, and range-of-motion testing of the foot by a physician or orthopedic specialist.
X-ray: Standard imaging to assess fractures, deformities, and joint changes.
MRI (Magnetic Resonance Imaging): Used when stress fractures, soft tissue lesions, or Morton neuroma are suspected.
Pedobarography / Plantar pressure analysis: Measurement of pressure distribution under the foot to evaluate structural abnormalities.

Treatment Options

Treatment depends on the specific condition:

Conservative therapy: Orthotic insoles, appropriate footwear, physiotherapy, offloading, and anti-inflammatory medications (e.g., NSAIDs) for metatarsalgia or splay foot.
Immobilization: Stress fractures are treated with rest and immobilization in a special walking boot or cast until healing is complete.
Surgical treatment: Surgery may be required for severe deformities such as hallux valgus or for treatment-resistant Morton neuroma.

References

Drake R.L., Vogl A.W., Mitchell A.W.M. – Gray's Anatomy for Students. 4th edition, Elsevier, 2019.
Schünke M., Schulte E., Schumacher U. – Prometheus Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme, 2018.
Coughlin M.J., Saltzman C.L., Anderson R.B. – Mann's Surgery of the Foot and Ankle. 9th edition, Elsevier Saunders, 2014.

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