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Second metatarsal bone

The second metatarsal bone is the longest and most stable metatarsal in the human foot. It lies between the first and third metatarsals, forming a central pillar of the forefoot and playing a crucial role in load distribution and propulsion during gait.

Its base is deeply recessed between the three cuneiform bones, giving it limited mobility but strong structural support. This anatomic configuration makes it particularly important in Lisfranc joint stability but also makes it prone to stress fractures and Lisfranc injuries due to repetitive forefoot loading.

Synonyms

  • Second ray of the foot

  • Middle metatarsal bone

Location and Articulations

  • Location: Central metatarsal located between the first and third metatarsals

  • Proximal articulation: With all three cuneiform bones (medial, intermediate, and lateral) — unique among metatarsals

  • Distal articulation: With the base of the second proximal phalanx (second toe)

  • Lateral articulations: With the bases of the first and third metatarsals via intermetatarsal joints

Surfaces and Features

  • Base (proximal end): Expanded and wedge-shaped, articulating with cuneiforms

  • Shaft (body): Long and narrow, slightly curved with a dorsal convexity

  • Head (distal end): Rounded, forming the metatarsophalangeal joint of the second toe

  • Tuberosities: Small dorsal and plantar projections for ligament and tendon attachment

Attachments

  • Muscles:

    • Dorsal interossei (first muscle): Originates from the medial side of the base

    • Plantar interossei (second): May attach on the lateral aspect (variable)

    • Extensor digitorum longus and brevis tendons: Insert distally into the dorsal expansion

    • Flexor digitorum longus and brevis tendons: Insert into the plantar base of the distal phalanx via the second toe flexor sheath

  • Ligaments:

    • Dorsal, plantar, and interosseous tarsometatarsal ligaments

    • Deep transverse metatarsal ligament

Relations

  • Superiorly: Dorsalis pedis artery and deep peroneal nerve

  • Inferiorly: Plantar aponeurosis and lumbrical muscle tendons

  • Medially: First metatarsal and medial cuneiform

  • Laterally: Third metatarsal and lateral cuneiform

  • Proximally: Tarsometatarsal joint (Lisfranc complex)

  • Distally: Metatarsophalangeal joint of the second toe

Arterial Supply

  • Dorsalis pedis artery via dorsal metatarsal branches

  • Plantar metatarsal arteries from the deep plantar arch

  • Nutrient arteries enter through the diaphysis

Venous Drainage

  • Dorsal venous arch and plantar venous network, draining into the posterior tibial and fibular veins

Function

  • Structural support: Acts as the central stabilizing pillar of the forefoot

  • Load transmission: Distributes weight evenly between medial and lateral columns

  • Propulsion: Contributes to toe-off during gait by transmitting forces to the second toe

  • Arch integrity: Maintains transverse and longitudinal arches through intermetatarsal connections

Clinical Significance

  • Stress fractures: Common in athletes, ballet dancers, and military recruits due to repetitive loading

  • Lisfranc injuries: Disruption between the base of the second metatarsal and cuneiforms destabilizes midfoot

  • Osteonecrosis: Rare, but may occur secondary to trauma or compromised vascularity

  • Infection or osteomyelitis: Seen in diabetic foot or trauma-related wounds

  • Imaging relevance: MRI and CT essential for detecting early stress changes or subtle joint instability

MRI Appearance

  • T1-weighted images:

    • Normal marrow: bright signal intensity, depending on fat content (fatty marrow = bright, hematopoietic = intermediate)

    • Cortex: dark hypointense rim

    • Stress fracture: linear low-signal line with surrounding marrow edema

    • Soft-tissue swelling or periosteal reaction may be evident

  • T2-weighted images:

    • Normal marrow: bright signal, influenced by fat content

    • Cortex: low signal

    • Pathology (stress fracture, contusion): linear or patchy hyperintensity with cortical disruption

    • Joint effusions or soft-tissue edema appear bright

  • STIR (Short Tau Inversion Recovery):

    • Normal marrow: dark signal

    • Bone marrow edema or stress injury: bright hyperintense area around fracture line

    • Useful for early detection of microfractures or osteomyelitis

  • Proton Density Fat-Saturated (PD FS):

    • Normal marrow: dark due to fat suppression

    • Pathology: bright signal in areas of edema, infection, or contusion

    • Helps distinguish between acute and chronic bone stress

  • T1 Fat-Sat Post-Contrast:

    • Normal marrow: mild homogeneous enhancement

    • Stress or infection: focal enhancement in marrow or periosteum

    • Abscess or osteomyelitis: peripheral or ring-like enhancement

CT Appearance

Non-Contrast CT:

  • Clearly visualizes cortical margins and trabecular structure

  • Stress fractures: show as fine cortical breaks or periosteal thickening

  • Lisfranc dislocation: widening between base of second metatarsal and medial cuneiform

  • Osteonecrosis: shows patchy sclerosis and cortical collapse

  • Osteomyelitis: cortical erosion and loss of trabecular pattern

Post-Contrast CT (standard):

  • Bone itself shows limited enhancement

  • Useful for detecting periosteal reaction, abscess formation, or soft-tissue inflammation

  • Excellent for evaluating fracture healing and bony alignment

CT VRT 3D image

Second Metatarsal Bone ct 3d vrt image

MRI image

second metatarsal bone coronal cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI image

second metatarsal bone axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

CT image

Second Metatarsal Bone ct axial

CT image

Second Metatarsal Bone ct sag image