The first metatarsal is the primary weight-bearing metatarsal at toe-off, transmitting 40-60% of forefoot load through the sesamoid complex. Its base articulates with the medial cuneiform at the first TMT joint — the site of Lapidus arthrodesis. Its head is divided into medial and lateral grooves by the intersesamoid crest. The first metatarsal is shortened in Morton's foot and long in hallux rigidus.
Hallux valgus produces lateral deviation of the great toe and medial deviation of the first metatarsal (metatarsus primus varus). The intermetatarsal angle (between 1st and 2nd metatarsal shafts) and hallux valgus angle (between 1st metatarsal and proximal phalanx) guide surgical correction choice.
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