The head of the first metatarsal is the large rounded far end of the first metatarsal, forming the ball of the big toe joint (first metatarsophalangeal joint). Its plantar surface has two grooves for the medial and lateral sesamoids, and it carries a large share of body weight during push-off. The bump on its inner side, the medial eminence, is where a bunion forms.
| Articulations |
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|---|---|
| Landmarks |
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| Ossification | Unlike the other metatarsals, whose growth plates are at the head, the first metatarsal grows from a growth plate at its base, so the head forms from the primary shaft centre that appears at about the 9th-10th fetal week. |
Normal walking needs roughly 60-65 degrees of big toe extension at this joint, so stiffness here changes gait and loads the lesser toes. In hallux valgus the head drifts toward the other foot while the big toe angles outward, making the medial eminence prominent. Sudden severe pain, redness and swelling over the head is the classic presentation of gout (podagra).
Follow the shaft of the first metatarsal along the inner border of the foot toward the big toe until you reach the rounded knob just behind the toe. Move the big toe up and down to locate the joint line just in front of it. The medial eminence is the bump on the inner side, the dorsal margin is felt on top, and the two sesamoids can be felt under the head on the sole as the toe is extended.
Outward angling of the big toe with inward drift of the first metatarsal head, causing a painful bump on the inner side of the foot.
Osteoarthritis of the first MTP joint with a dorsal bone spur that limits big toe extension and causes pain on push-off.
Urate crystal arthritis that most often first affects this joint, causing intensely painful, hot swelling.
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