The human foot is an intricate structure, composed of 26 bones, 33 joints, over 100 ligaments, and numerous muscles, all working in concert to provide support, balance, and mobility. These components are organized into three main sections: the hindfoot, midfoot, and forefoot. Within the forefoot, five long bones, known as metatarsals, connect the ankle to the toes, distributing body weight and enabling movement. The second metatarsal bone is located in the central region of the forefoot.
Anatomy and Function
The second metatarsal bone is located between the first (big toe side) and third metatarsals. It is the longest of the five metatarsal bones, characterized by its slender shaft, a proximal base, and a distal head. Its base articulates with the three cuneiform bones (medial, intermediate, and lateral). Its distal head connects with the base of the second toe’s proximal phalanx, forming the metatarsophalangeal joint.
This bone contributes to weight-bearing during standing and locomotion. It helps distribute the body’s weight across the forefoot and provides leverage for actions like walking, running, and jumping. The second metatarsal also plays a role in maintaining the foot’s arch structure, which is important for balance and shock absorption. Its stable articulation with the cuneiform bones, particularly the intermediate cuneiform, helps anchor the midfoot.
Common Conditions and Injuries
The second metatarsal is susceptible to several conditions and injuries, often due to its length and the forces it endures. Stress fractures are common, tiny cracks in the bone caused by repetitive impact and overuse, frequently seen in athletes involved in high-impact activities like running, basketball, or dance. Symptoms include pain that gradually worsens with activity, localized tenderness, and sometimes swelling over the fracture site. This pain may even persist at night, indicating a stress fracture.
Freiberg’s disease is another condition affecting the second metatarsal, characterized by avascular necrosis—the death of bone tissue due to disrupted blood supply—primarily at the metatarsal head. It is thought to involve repetitive physical stress and microfractures that impede blood flow, commonly affecting adolescent girls. Symptoms include pain in the ball of the foot, stiffness in the toes, swelling, and a sensation of walking on a hard object.
Metatarsalgia refers to general pain and inflammation in the ball of the foot, specifically affecting the area around the second metatarsal head. This can result from excessive pressure, such as from high-impact activities, ill-fitting footwear, or certain foot deformities like a high arch or a longer second toe, which can shift more weight onto this area. The pain can be sharp, aching, or burning, and may worsen with standing, walking, or running, sometimes accompanied by numbness or tingling in the toes.
Diagnosis and Treatment Approaches
Diagnosing issues related to the second metatarsal bone begins with a thorough physical examination by a medical professional, who will assess the foot, observe gait, and inquire about symptoms and potential causes. Imaging techniques are employed to confirm a diagnosis or rule out other conditions. X-rays are used to identify fractures or bone abnormalities, though subtle stress fractures may not be immediately visible. In such cases, a magnetic resonance imaging (MRI) scan or a bone scan may be recommended, as they can provide more detailed images of both bone and soft tissues, helping to detect smaller fractures, inflammation, or other underlying issues.
Treatment approaches for second metatarsal conditions prioritize non-surgical interventions. Rest, ice, compression, and elevation (RICE protocol) are standard initial steps to reduce pain and inflammation. Over-the-counter pain relievers may be used for pain management. Activity modification, reducing or avoiding activities that worsen symptoms, is also important.
Supportive footwear with adequate cushioning, a wide toe box, and low heels can help redistribute pressure. Orthotics are prescribed to provide arch support and further reduce pressure on the metatarsal heads. Physical therapy can aid in restoring proper foot mechanics and improving recovery. If conservative treatments do not provide sufficient relief, surgical options may be considered, such as metatarsal osteotomy or soft tissue procedures. The goal of surgery is to alleviate pain and restore function.