What You Should Know About the Forefoot

You may be surprised to learn that your forefoot carries and balances half of the body's total weight, and is designed to handle significant force and wear-and-tear.

Structure of the Forefoot

The forefoot is one of the three primary regions of the foot, in addition to the midfoot and the rearfoot (or hindfoot). It is composed of tendons, ligaments, soft tissue, and 19 bones in five toes, also known as the phalanges.

Phalanges
Four of the toes are made up of three phalanx bones:

• the proximal phalanx
• the intermediate phalanx
• the distal phalanx

The hallux, also known simply as the big toe, has only two phalanx bones: the proximal and distal phalanges. 

Metatarsal Bones
Five metatarsal bones connect to the proximal phalanges at the joints in the balls of the feet. They line up side by side in the middle of the foot. Each of the metatarsal bones is referred to by their position relative to the medial side of the foot—the side with the big toe:

• First metatarsal (behind the big toe)
• Second metatarsal
• Third metatarsal
• Fourth metatarsal
• Fifth metatarsal (behind the little toe)

The forefoot also has a complex network of ligaments crossing and running along the length of the foot. Ligaments serve several purposes:

• Connect bones and skin
• Support and insulate the foot by holding fat in place to act as cushions
• Help nerves, tendons, and blood vessels pass beneath the heads of the metatarsal bones

• Tie the arches

Common Problems in the Forefoot

Metatarsalgia
Pain in the forefoot is generally called metatarsalgia. The pain can manifest as burning, aching or shooting pain in the toes, often in the ball of the foot, and can be aggravated by walking or running. Injuries and inflammation are often suffered to the forefoot during sports activities.

These can often be traced back to abnormal weight distribution during these activities.

Morton's neuroma is a condition that can cause metatarsalgia pain, and occasionally toe numbness. It is caused by nerve inflammation and irritation between the metatarsal heads.

Causes of metatarsalgia may include:

• Hammer toes
• Excess weight
• Tightness in the Achilles tendon
• Highly active sports and other activities
• Tight extensors
• Weak flexors
• Overpronation
• Poorly fitting footwear

Fractured Toe Bones
Broken toes are common, usually caused by something heavy hitting them or stubbing a toe against an object. They are quite painful and can make walking difficult. Serious fractures left untreated can heal incorrectly and cause other issues.

Hammer Toes
Hammertoes are a common foot problem that can affect one or more toes, though it is uncommon in the big toe. Weak muscles in the toes allow tendons to shorten and thus pull the toe back toward the foot, causing the elevated joint and the "hammered" appearance of the toe.

Osteoarthritis
Osteoarthritis is a degenerative disease of joints in which the cushion between joints, known as cartilage, deteriorates. Foot deformities, sprains, and injuries to the foot may also contribute to osteoarthritis.

Osteophytes (Bone Spurs)
Osteophytes, also known as bone spurs, are growths or projections of bone that can develop along joints. They can appear in those with osteoarthritis. They often cause pain and can limit joint movement.