The Monday Shakeout: All About the 1st MTP Joint
By Andrea Myers
Andrea takes on this week's Monday Shakeout to talk about a joint she refers to quite often in her reviews, the 1st MTP. She goes in-depth in this week's article, covering what the 1st MTP is and why it is important in regards to running.
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| This photo has both everything and nothing to do with this article. |
The 1st metatarsophalangeal (MTP) joint plays an important role in running biomechanics and is a common location for injury. A joint is where two or more bones meet, typically with the function of producing motion. The 1st MTP joint consists of the 1st metatarsal, which is one of five metatarsals in the forefoot, and the 1st proximal phalanx, which is one of the bones that makes up the big toe.
How the 1st MTP is Connected
While many people think of the 1st MTP joint as a hinge joint like the knee, it is actually a condyloid joint that allows flexion and extension (curling the toe and pulling the toe toward the shin) as well as abduction and adduction (moving the big toe away from and towards the second toe). The joint receives most of its stability from the soft tissue around it, rather than the bony shape of the joint itself.
The muscles that play a role in stabilizing the joint are
- the flexor hallucis brevis, which is a muscle that bends the big toe,
- the adductor hallucis, which squeezes the big toe towards the second toe and bends it, and
- the abductor hallucis, which pulls the big toe away from the second toe and bends it.
The soft tissue that stabilizes the 1st MTP joint includes the joint capsule,
the ligaments and muscles listed above that surround the joint, and two tiny bones
called sesamoid bones. A sesamoid bone is a bone located in a tendon, with the most well-known sesamoid bone being the patella (kneecap). There are many sesamoid bones located throughout the human body, with most being located in the foot and hand.
Sesamoid bones have multiple functions, including tendon protection and improving the mechanical advantage of the involved muscle. The two sesamoid bones associated with the 1st MTP joint are embedded in the flexor hallucis brevis tendon, and are called the tibial and fibular sesamoids (named for their relative location on the tibial or fibular side of the 1st MTP). The sesamoids protect the 1st metatarsal head when the 1st MTP is in dorsiflexion, which is the position of the joint during push off. The sesamoid bones can become inflamed or fractured in runners due to their location and protective role.
Functions of the 1st MTP
No joint in the human body works in isolation, and the 1st MTP joint is no exception. Due to the attachment of the plantar fascia at the 1st MTP joint, the 1st MTP also plays a vital role in the windlass mechanism, which refers to the resulting increase in tension in the plantar fascia when the 1st MTP is extended.
During walking or running, when the heel rises as the foot progresses from mid stance to push off, the 1st MTP joint extends, which puts tension on the plantar fascia. This tension helps bring the heel and forefoot closer together, raising the medial longitudinal arch and assisting with re-supination of the foot, which is vital for optimal propulsion at push off.
During running, the 1st MTP joint supports double the load of the 2nd-5th MTPs and peak forces on the joint are 2-3x body weight. Normal passive extension range of motion of the 1st MTP is around 85 degrees and walking requires about 65 degrees of motion. Running may require up to 85 degrees of motion, but the exact amount depends on footwear type and each individual's biomechanics. Static tests of 1st MTP extension range of motion have been found to not correlate with the amount of extension that occurs during walking or running.
A study in the Journal of Orthopedic and Sports Physical Therapy in 2006 found no relationship between weight bearing passive 1st MTP extension (referring to standing and lifting your big toe off the ground with your hands) and the amount of 1st MTP extension observed in the same subject while walking. Another study in 2020 that assessed several methods of determining whether a person has functional hallux limitus (reduced 1st MTP extension range of motion) found that the presence of a pinch callus was the sign most associated with the condition (as compared to static measurements of 1st MTP extension range of motion). A pinch callus results from the medial aspect of the big toe rubbing on the shoe at push off due to limited 1st MTP extension range of motion. If you get a pinch callus from running in a particular pair of running shoes, it may be a indication that your functional 1st MTP range of motion is not sufficient for the geometry of the shoes.
If a runner has insufficient functional 1st MTP extension range of motion, the body will attempt to compensate by stealing motion from other joints. Common compensations include tibial external rotation, higher cadence/shorter stride, excessive pronation (resulting in rolling off the medial side of the great toe and causing a pinch callus), inadequate pronation (resulting in push off occurring at the lesser MTPs), or excessive ankle, knee, or hip motion. These compensations can often lead to injury, which often cannot be fully treated until the root problem (1st MTP range of motion) is addressed.
Causes of Limited 1st MTP Range of Motion
One of the most common causes of limited 1st MTP range of motion is hallux valgus. Hallux valgus occurs when the head of the 1st metatarsal deviated medially, causing the 1st toe to point towards the 2nd toe. There are multiple potential causes of hallux valgus, including genetics, and it occurs more frequently in women. The most common environmental cause of bunions is wearing shoes that are too tight in the toe box, particularly pointed or high heeled shoes. The bump that forms on the medial side of the joint is called a bunion, and consists of a callus, a thickened bursa, and extra bone growth called an exostosis. The change in alignment of the 1st metatarsal and 1st proximal phalanx, in addition to soft tissue changes, result in reduced range of motion of the joint, which can make walking or running difficulty and/or painful.
Best Practice for 1st MTP Health and Shoe Types to Look For
The most important thing that runners can do for their 1st MTP joint health is to make sure that their shoes fit appropriately, both in length and width. For more on the importance of toe box width, check out this article.:
For runners who have reduced 1st MTP joint motion, a shoe that has a stiff forefoot in addition to a forefoot rocker will reduce the amount of 1st MTP motion required for push off. Check out Matt's Shakeout on the topic here.
References
Anderson R, Great-Toe Disorders. In: Porter D, Schon L, eds. (2021). Baxter’s The Foot and Ankle In Sport. (3 ed., pp.390-410). Elsevier.
Magee, D. (2014). Orthopedic Physical Assessment (6 ed., pp.891-909). Elsevier.
Neumann, D. (2002). Kinesiology of the Musculoskeletal System (pp.504-505). Mosby.
Lucas, R., & Cornwall, M. (2017). Influence of foot posture on the functioning of the windlass mechanism. Foot (Edinburgh, Scotland), 30, 38–42.
Sánchez-Gómez, R., Becerro-de-Bengoa-Vallejo, R., Losa-Iglesias, M. E., Calvo-Lobo, C., Navarro-Flores, E., Palomo-López, P., Romero-Morales, C., & López-López, D. (2020). Reliability Study of Diagnostic Tests for Functional Hallux Limitus. Foot & ankle international, 41(4), 457–462.
Halstead, J., & Redmond, A. C. (2006). Weight-bearing passive dorsiflexion of the hallux in standing is not related to hallux dorsiflexion during walking. The Journal of orthopaedic and sports physical therapy, 36(8), 550–556.
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NEXT: What is Drop and Why It Doesn't Always Matter