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Wednesday, June 26, 2013

First Metatarsal Position: Important to Know with Metatarsal Problems

One important measurement that bio mechanic specialists evaluate is the relationship of the first metatarsal to the second metatarsal head. The foot should be centered under the ankle joint (therefore not pronated or supinated). One thumb on bottom and index finger on top grab the second metatarsal head and stabilize it. This will be the reference point. With the other hand, grab the first metatarsal head also from top and bottom. See where the first metatarsal head lies in relation to the second metatarsal head when the thumb fingernails are parallel. Then move the first metatarsal head up and down noting the overall motion and position. The motion is ideally 5 mm up and 5 mm down. In this patient, the left first metatarsal moved only 2 mm total (4 mm down and -2 mm up). This is called a stable plantar flexed first ray. Ideally the first and fifth metatarsal heads are lower than their adjacent metatarsals.

On this patient's right foot, the first metatarsal rested 3 mm above the second metatarsal. The overall motion with 6 mm (6 mm up and 0 mm down). This is called an elevated first ray or metatarsus primus elevatus (I love to talk like I am smart!!) This is an unstable first metatarsal that will not hold up the arch, and causes instability in the foot. It can be the cause of bunions or produced by the formation of a bunion. When recognized, orthotic modifications like the Cluffy Wedge or Morton's Extension  can be used, and if surgery is being done, corrections for the elevated bone can be done. With an elevated first metatarsal, the weight goes more to the second and sometimes third metatarsals leading to pain syndromes like metatarsalgia, capsulitis, neuromas, and hammertoes. 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.