The first metatarsophalangeal joint is one of the most mechanically loaded joints in the body, bearing forces up to eight times body weight during running push-off. The two sesamoid bones on its plantar surface distribute this load and protect the flexor hallucis longus tendon. It is the joint affected in gout, hallux valgus, and hallux rigidus, three of the most common forefoot conditions.
Hallux valgus deformity (bunion) produces a progressive lateral deviation of the great toe with a medial bony prominence at the first MTP joint that causes shoe rubbing and functional gait changes. Hallux rigidus is degenerative arthritis of the first MTP joint producing dorsiflexion restriction and pain with push-off. Gout classically presents as an exquisitely painful acute arthritis of this joint in hyperuricaemic individuals. Turf toe is an acute hyperextension sprain of the plantar plate and sesamoid complex from forced great toe dorsiflexion.
Progressive lateral deviation of the great toe at the first MTP joint with medial eminence formation producing shoe fitting problems and gait alteration, managed with orthoses and shoe modification or surgical correction for severe deformity.
Hyperextension sprain of the first MTP joint plantar plate from forced great toe dorsiflexion on hard artificial surfaces, producing plantar joint pain and instability that can be career-affecting in professional athletes.
Degenerative arthritis of the first MTP joint producing dorsiflexion restriction and push-off pain managed with rocker-soled footwear and ultimately fusion or arthroplasty.
