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Second toe

The second toe (digitus secundus pedis) is the longest and most centrally positioned toe of the foot. It plays an essential role in balance, propulsion, and load transfer during gait. Structurally, it consists of three phalanges (proximal, middle, and distal) that articulate through interphalangeal joints, supported by surrounding ligaments, tendons, and soft tissues.

Functionally, the second toe acts as a stabilizer and propulsive lever, sharing load distribution with the hallux (great toe) during push-off. Clinically, it is often involved in deformities such as hammer toe, claw toe, Morton’s toe, and plantar plate tears at the metatarsophalangeal (MTP) joint.

Synonyms

  • Second digit of the foot

  • Second ray of the foot

Bones and Joints

  • Proximal phalanx: Articulates with the second metatarsal head at the MTP joint

  • Middle phalanx: Articulates with proximal and distal phalanges at the interphalangeal joints

  • Distal phalanx: Supports the nail bed and distal pad of the toe

  • Joints:

    • Metatarsophalangeal (MTP) joint — stabilized by the plantar plate, collateral ligaments, and joint capsule

    • Proximal interphalangeal (PIP) joint and distal interphalangeal (DIP) joint — stabilized by collateral ligaments and extensor expansions

Tendons and Attachments

  • Extensor tendons (dorsal surface):

    • Extensor digitorum longus (EDL): Inserts via dorsal digital expansion on distal phalanx

    • Extensor digitorum brevis (EDB): Contributes to dorsal expansion on the proximal phalanx

  • Flexor tendons (plantar surface):

    • Flexor digitorum longus (FDL): Inserts on base of distal phalanx for distal toe flexion

    • Flexor digitorum brevis (FDB): Inserts on middle phalanx for proximal flexion

  • Intrinsic stabilizers: Lumbrical (medially) and interossei (laterally) help maintain toe alignment and balance

Relations

  • Dorsally: Extensor tendons and dorsal digital veins

  • Plantar surface: Plantar plates, flexor tendons, and digital nerves

  • Medially: First intermetatarsal space (between first and second toes)

  • Laterally: Third toe and corresponding intermetatarsal space

Nerve Supply

  • Plantar digital branches of the medial and lateral plantar nerves (from the tibial nerve)

  • Dorsal digital branches of the deep fibular (peroneal) nerve

Arterial Supply

  • Plantar digital arteries from the plantar metatarsal arteries (branches of deep plantar arch)

  • Dorsal digital arteries from the dorsal metatarsal arteries

Venous Drainage

  • Dorsal digital veins drain into the dorsal venous arch

  • Plantar veins drain into the posterior tibial vein

Function

  • Flexion and extension: Enables toe movement at MTP, PIP, and DIP joints

  • Balance and propulsion: Central role in push-off during gait cycle

  • Shock absorption: Distributes body weight across forefoot

  • Arch stabilization: Supports transverse and longitudinal arches

  • Fine motor control: Assists in subtle adjustments during stance and walking

Clinical Significance

  • Deformities: Hammer toe, claw toe, Morton’s toe (elongated second toe), or crossover deformity

  • Plantar plate tear: Common at 2nd MTP joint; causes pain, swelling, and instability

  • Dislocations: MTP joint dislocation may occur with hyperextension injuries

  • Tendinopathy: Chronic overuse may cause flexor or extensor tendon inflammation

  • Surgical relevance: Plantar plate repair and digital realignment procedures often involve the second toe

MRI Appearance

  • T1-weighted images:

    • Normal muscles: intermediate signal intensity

    • Tendons: low signal (dark) coursing along dorsal and plantar surfaces

    • Bone marrow: intermediate signal in phalanges

    • Fat planes between tendons and bones: bright

    • Plantar plate: low-signal band beneath the MTP joint

  • T2-weighted images:

    • Muscles: intermediate-to-low signal, slightly darker than T1

    • Tendons: low signal, continuous structure

    • Pathology: hyperintense signal in plantar plate or tendons indicating tear or inflammation

    • Joint effusion or synovitis: bright signal around MTP joint capsule

  • STIR:

    • Normal muscles: intermediate-to-dark signal intensity

    • Pathologic regions (edema, inflammation, tear): bright hyperintense areas in muscle, plantar plate, or subcutaneous tissues

    • Useful for detecting early stress injuries or soft tissue swelling

  • Proton Density Fat-Saturated (PD FS):

    • Normal: intermediate-to-dark muscle and low-signal tendon

    • Pathologic: bright hyperintensity within tendon or around plantar plate (indicative of tendinopathy or tear)

    • Excellent for differentiating plantar plate injuries from simple capsulitis

  • T1 Fat-Sat Post-Contrast:

    • Normal muscles and tendons: mild homogeneous enhancement

    • Inflamed capsule, tendon sheath, or plantar plate: enhanced signal

    • Chronic fibrosis or scarring: low central signal with peripheral enhancement

CT Appearance

Non-Contrast CT:

  • Bones: clearly visualized — proximal, middle, and distal phalanges with cortical detail

  • Joints: visible articulations with thin cartilage margins

  • Tendons and soft tissues: appear as low-density structures

  • Degenerative changes: joint space narrowing, osteophytes, or subchondral sclerosis

Post-Contrast CT (standard):

  • Muscles: homogenous enhancement

  • Inflamed tendon sheaths or soft-tissue masses: show focal enhancement

  • Excellent for evaluating bony deformities, sesamoid variants, or fractures involving the 2nd MTP joint

MRI image

Second toe of foot axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

CT image

Second toe CT coronal image