Definition
The metatarsophalangeal joint of the big toe (Articulatio metatarsophalangeles I) forms the connection between the metatarsal bone (Os metatarsum I) and the corresponding distal phalanx of the toe. It allows two main movements, which are strongly restricted by tight ligaments. The metatarsophalangeal joint of the big toe is a ball-and-socket joint and its movement is strongly restricted by concentric collateral ligaments.
For this reason, only two movements are possible in this joint: particularly pronounced is flexion towards the sole of the foot (plantar flexion) up to about 40° and extension towards the back of the foot (dorsal extension) up to about 50°. Spreading movements (abduction and adduction) of the metatarsophalangeal joint are possible to a small extent in the extension position of the joint. The flexure of the metatarsophalangeal joint is performed by the long and short flexor muscle of the big toe (Mm.
Flexores hallucis longus and brevis). The extension is made possible by the long and short extensor muscle of the big toe (Mm. Extensores hallucis longus and brevis).
The metatarsophalangeal joint of the big toe is formed by the first metatarsal bone and the base of the first phalanx close to the body. The flaccid joint capsule is reinforced by two collateral ligaments (medial and lateral collaterals) on the side of the joint and several ligaments on the sole of the foot (plantar ligaments). These ligaments are the reason for the severe movement restriction of the basic joint.
The medial and lateral ligaments (Ligamentum plantar medial and lateral) each contain a sesamoid bone. These serve for articulation with the head of the first metatarsal bone and form a separate joint here. On the side of the back of the foot (dorsal), the metatarsophalangeal joint is covered by fibrous tissue.
These come from the tendons of the extensor muscles of the toes (extensors). The hallux valgus is caused by a base joint of the big toe that is angled to the side. This causes the ball of the toe to protrude strongly.
In women, wearing shoes that are too tight and too pointed is said to contribute to the development of hallux valgus. A further disease is the hallux rigidus. This is a wear-related stiffening of the metatarsophalangeal joint of the big toe.
This leads to restricted movement and pain. The clinical picture of gout is caused by the deposition of uric acid crystals, especially in joints. The metatarsophalangeal joint of the big toe is particularly often affected.
The inflammation of the metatarsophalangeal joint of the big toe is generally known as “hallux rigidus“. This is an arthritic change which, if left untreated, can lead to severe functional limitations and even to complete stiffening (see below). It is caused by wear and tear of the cartilage, which can occur for no apparent reason or is the result of a severe strain on the person.
Gout, i.e. the deposition of uric acid crystals in the joint, can also be the cause of this cartilage damage. In the long run, such an inflammation leads to swelling, pain and a relieving posture while rolling the foot, which is caused by the pain and the increasing stiffening and functional impairment. The inflammation in the metatarsophalangeal joint of the big toe can be treated by a combination of relief and medication.
Special shoes and insoles can support the rolling movement and at the same time relieve the joint. Anti-inflammatory drugs and hyaluronic acid injections are recommended to maintain the compressive strength of the cartilage. For example, if the bone is deformed, surgical measures in the form of partial resections of the bones may also be appropriate to relieve the metatarsophalangeal joint of the big toe.
Pain in the metatarsophalangeal joint of the big toe can be caused by traumatic changes such as fractures, gout in the joint or unphysiological pressure loads, or even deformations of the bone. Hallux rigidus“, an inflammation caused by age or circumstances, is also a common cause of pain. The form and occurrence of the pain can often already help to narrow down the causes.
Here one should examine whether the pain always occurs or only when movement or pressure is applied. A typical example is a limping gentle gait, which is often taken in case of arthritic changes of the joint. When addressing the cause, it is important to ensure that no such gentle gait or malpositioning occurs so that the joint can heal completely and without permanent functional impairment.
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