Fact-sheet: Second metatarsal overload syndrome


Updated on 11/07/2024 at 2:31 PM

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Definition

Painful instability due to stretching and subsequent rupture of the plantar plate, beginning at the 2nd ray MTP joint (stabilizing fibrocartilage of the MTP joint).

Syndrome favored by:

  • insufficiency of the 1st ray, which increases the load on the 2nd MTP joint
  • verticalization of the metatarsals, which increases the load and favors extension of P1: cavus feet, high heels
  • conditions causing capsular distension of the 2nd MTP joint
  • repeated trauma

Clinical features

2nd ray metatarsalgia

3 phases

  • Painful instability of the 2nd MTP joint
  • Reducible dorsal subluxation of P1 of the 2nd toe, callus under the M2 head, and microtraumatic synovitis
  • Fixed dorsal dislocation of the base of P1 on the head of M2 and PIP joint hammer toe deformity

Radiography

  • Dorsal subluxation or dislocation of the base of P1 of the 2nd toe on the medial oblique foot view
  • Medial deviation of the 2nd ray
  • Pseudo-narrowing of the 2nd MTP joint on the AP view

Ultrasound

  • Early synovitis with effusion of the 2nd ray MTP joint
  • Dorsal subluxation of the base of P1 of the 2nd ray
  • Plantar plate injury: thinning, partial or complete tear, usually at the insertion of the plate on P1
  • Tenosynovitis of the flexor tendons of the 2nd ray at the level of the MTP joint

Value of dynamic maneuvers with dorsal and plantar flexion of the 2nd toe and compression of the dorsal aspect of the metatarsal heads

MRI

  • Plantar plate rupture (normally T1 and T2 hypointense)
  • Dorsal subluxation of the base of P1 of the 2nd ray
  • Synovitis and effusion of the 2nd MTP joint
  • Tenosynovitis of the flexor tendons of the 2nd ray
  • Possible rupture of the lateral collateral ligament of the 2nd MTP joint