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Metatarsals (1-5)

ossa metatarsi

The five metatarsals form the forefoot between the tarsal bones and the toes, numbered 1 (great toe) to 5 (little toe). The head of the first metatarsal bears most forefoot loading, while the fifth metatarsal base is the most commonly avulsed in lateral ankle sprains.

Anatomical Data

Structure & Landmarks

Articulations	Cuneiform and cuboid at CMT joints proximally Proximal phalanges at MTP joints distally Adjacent metatarsals via interosseous ligaments
Landmarks	Head (forming metatarsal break) Shaft Base Styloid process of fifth metatarsal (peroneus brevis insertion)
Ossification	Metatarsals 2 through 5 have proximal epiphyses. First metatarsal ossifies like a phalanx with a distal epiphysis. Primary centres present at 9 to 10 weeks of fetal life.

Clinical Relevance

Clinical Notes

Metatarsal fractures are common foot injuries. Fifth metatarsal fractures require distinction between three injury patterns: styloid avulsion (peroneus brevis, conservative), Jones fracture at the metaphyseal-diaphyseal junction (high non-union risk, fixation recommended in athletes), and diaphyseal stress fracture (activity modification, fixation for non-healing). March fractures are metatarsal stress fractures from sudden increase in walking, most common at the second and third metatarsal shafts.

Pathology

Common Injuries & Conditions

Metatarsal Stress Fracture

The classic march fracture, most often in the second or third metatarsal neck, from repetitive loading in runners and recruits.

Fifth Metatarsal Base Fracture

Fractures range from avulsion of the tuberosity to the Jones fracture at the metaphyseal-diaphyseal junction, which has a high non-union rate.

Freiberg Disease

Osteonecrosis of the second metatarsal head, mainly in adolescent girls, causing forefoot pain.

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