Foot Health What You Should Know About the Forefoot The forefoot contains the most bones of the three areas of the foot By Terence Vanderheiden, DPM Terence Vanderheiden, DPM Terence Vanderheiden, DPM, is a podiatrist in Massachusetts with a subspecialty in the area of podiatric sports medicine. Learn about our editorial process Updated on April 05, 2022 Medically reviewed by Adam H. Kaplan, DPM Medically reviewed by Adam H. Kaplan, DPM Facebook LinkedIn Adam H. Kaplan, DPM, is a podiatrist who has been in private practice for over 5 years in New Jersey and specializes in a wide scope of foot care. Learn about our Medical Expert Board Print You may be surprised to learn that your forefoot carries and balances nearly half of the body's total weight, and is designed to handle significant force and wear-and-tear. SEBASTIAN KAULITZKI / Science Photo Library / Getty Images 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 phalanxThe intermediate phalanxThe 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 metatarsalThird metatarsalFourth metatarsalFifth 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 skinSupport and insulate the foot by holding fat in place to act as cushionsHelp nerves, tendons, and blood vessels pass beneath the heads of the metatarsal bonesTie 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 toesExcess weightTightness in the Achilles tendonHighly active sports and other activitiesTight extensorsWeak flexorsOverpronationPoorly 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. 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Tovaruela-Carrión N, López-López D, Losa-Iglesias ME, et al. Comparison of health-related quality of life between patients with different metatarsalgia types and matched healthy controls: a cross-sectional analysis. Sao Paulo Medical Journal. 2018 Oct;136(5):464-471. doi:10.1590/1516-3180.0220190918 Santiago F, Muñoz P, Pryest P, Martínez A, Olleta N. Role of imaging methods in diagnosis and treatment of Morton's neuroma. World J Radiol. 2018 Sep;10(9):91-99. doi:10.4329/wjr.v10.i9.91 Chahal GS, Davies MB, Blundell CM. Treating metatarsalgia: current concepts. Orthopaedics and Trauma. 2020 Dec;34(1):30-36. doi:10.1016/j.mporth.2019.11.005 American Academy of Orthopedic Surgeons. Toe and forefoot fractures. Reviewed June 2016. American Academy of Orthopedic Surgeons. Hammer toe. Roddy E, Menz H. Foot osteoarthritis: latest evidence and developments. Thera Adv in Musculo Dis. 2018 Jan;10(4):91-103. doi:10.1177/1759720X17753337 Additional Reading Ghanem I, Massaad A, Assi A, et al. Understanding the foot’s functional anatomy in physiological and pathological conditions: the calcaneopedal unit concept. J Child Orthop. 2019 Apr;13(2):134-146. doi:10.1302/1863-2548.13.180022 Hung C-Y, Chang K-V, Mezian K, et al. Advanced ankle and foot sonoanatomy: imaging beyond the basics. Diagnostics. 2020 Mar;10(3):160. doi:10.3390/diagnostics10030160 Ohlendorf D, Kerth K, Osiander W, et al. Standard reference values of weight and maximum pressure distribution in healthy adults aged 18–65 years in Germany. J Physiol Anthropol. 2020 Nov;39(1):39. doi:10.1186/s40101-020-00246-6 Patil S, Hanumantharaya GH, Desai SP, Nidoni M. Radiological biometric study of metatarsals and phalanges. J Clin Diagn Res. 2017 Sep;11(9):5-9. doi:10.7860/JCDR/2017/27887.10589 By Terence Vanderheiden, DPM Terence Vanderheiden, DPM, is a podiatrist in Massachusetts with a subspecialty in the area of podiatric sports medicine. 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