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# Second metatarsal

The second metatarsal is the longest foot bone behind the second toe; its base locks into the midfoot like a keystone.

Official name: Second

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## What it is

The longest metatarsal, behind the second toe. Its base locks into a notch among the cuneiforms like a keystone.

## What it does

The metatarsals spread weight across the ball of the foot and act as levers when you push off.

## Key points

- The commonest site of march fracture, usually in the neck or distal shaft
- A long second metatarsal overloads its head: metatarsalgia, plantar plate tears and a crossover second toe
- Freiberg disease: osteonecrosis of the metatarsal head, most often the second, typically in adolescent girls
- Fracture or displacement at its base is the hallmark of a Lisfranc injury

## Key facts

**Joints with**
All three cuneiforms; third metatarsal; proximal phalanx of second toe

**Landmarks**
Longest metatarsal; base keyed into cuneiform recess (keystone of tarsometatarsal joint); Lisfranc ligament; common stress (march) fracture site

## Relations

**Behind**
Base locked between the medial, intermediate and lateral cuneiforms; Lisfranc ligament to the [medial cuneiform](https://durgical.com/en/anatomy/medial-cuneiform-bone/)

**In front**
Head with the plantar plate and the proximal phalanx of the [second toe](https://durgical.com/en/anatomy/second-toe/)

**Medial**
First intermetatarsal space with the first dorsal interosseous and the deep plantar artery

**Lateral**
[Third metatarsal](https://durgical.com/en/anatomy/third/) and the second dorsal interosseous

**Below**
Oblique head of [adductor hallucis](https://durgical.com/en/anatomy/adductor-hallucis/) from the bases of metatarsals 2–4; [plantar interossei](https://durgical.com/en/anatomy/plantar-interossei-muscles/) of the neighbouring rays

**Above**
[Extensor digitorum longus](https://durgical.com/en/anatomy/extensor-digitorum-longus/) tendon to the second toe; the [dorsalis pedis artery](https://durgical.com/en/anatomy/dorsalis-pedis-artery/) near its base

## How to find it

Followed on the dorsum from its base, just in front of the [intermediate cuneiform](https://durgical.com/en/anatomy/intermediate-cuneiform-bone/), to the head. Under the ball of the foot its head is often the most prominent. Localised dorsal tenderness and swelling over the shaft suggest a stress fracture.

## Examination

- Vertical stress (drawer) test of the second toe: lifting the toe straight up on the steadied metatarsal head; pain and extra upward glide suggest a plantar plate tear

## On imaging

Stress fractures often show only after 2–3 weeks, as periosteal new bone; MRI or bone scan shows them earlier. Standing AP view for its alignment with the intermediate cuneiform. In Freiberg disease the head is flattened and sclerotic.

## Common problems

- Stress fractures, common in runners and military recruits ('march fracture').
- Pain under its head (metatarsalgia).

## Clinical notes

- Weil osteotomy shortens a long second metatarsal to unload its head
- Second metatarsal base fractures in a twisting or crushing midfoot injury warrant a search for Lisfranc instability

## Anatomical variants

- The second metatarsal is usually the longest; a markedly long one, often with a second toe longer than the [big toe](https://durgical.com/en/anatomy/great-toe/) (Morton or Greek foot), is a common variant

## Development

Its secondary centre is at the head, as in metatarsals 3–5.

## Related conditions

- [Metatarsal fractures (including stress fractures)](https://durgical.com/en/conditions/metatarsal-fractures/)

## Test yourself

Think of the answer, then tap the question to see it.

## Which metatarsal is the commonest site of march fracture?

The second metatarsal, usually at the neck or distal shaft.

## What is Freiberg disease?

Osteonecrosis of a metatarsal head, most often the second, typically in adolescent girls.

## Why does a fracture at the base of the second metatarsal raise concern for a Lisfranc injury?

The base is the keystone locked among the cuneiforms; fracture or displacement there is the hallmark of a Lisfranc injury.

## Why can a long second metatarsal cause problems at its head?

It overloads the head: metatarsalgia, plantar plate tears and a crossover second toe.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
os metatarsi II TA2 1496

**Official Spanish (DeCS)**
Segundo metatarsiano DeCS D008682

**English (TA2)**
Second

## Related

- [Intermediate cuneiform](https://durgical.com/en/anatomy/intermediate-cuneiform-bone/)
- [Second toe](https://durgical.com/en/anatomy/second-toe/)
- [Lisfranc ligaments](https://durgical.com/en/anatomy/cuneometatarsal-interosseous-ligaments/)
- [Adductor hallucis](https://durgical.com/en/anatomy/adductor-hallucis/)
- [Dorsal interossei](https://durgical.com/en/anatomy/dorsal-interossei-muscles-of-foot/)
- [Toe extensor tendons](https://durgical.com/en/anatomy/tendons-of-extensor-digitorum-longus/)
- [Extensor digitorum brevis](https://durgical.com/en/anatomy/extensor-digitorum-brevis/)
- [Extensor hallucis brevis](https://durgical.com/en/anatomy/extensor-hallucis-brevis/)

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=22943&filter=ths_termall&q=Huesos%20Metatarsianos); [Anatomy, Bony Pelvis and Lower Limb: Metatarsal Bones](https://www.ncbi.nlm.nih.gov/books/NBK549872/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/second/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/second/