Plantar flexed 1st ray


Dr Information

Summary – A plantar-flexed 1st ray is a sagittal plane forefoot abnormality, when the 1st metatarsal is plantar-flexed compared to the lesser digits. This will greatly increase the pressure on the 1st MPJ and will reduce the ability for this joint to work effectively, this can cause conditions such as sesamoiditis, capsulitis and Osteoarthritis of the 1st MPJ. Plantar flexed 1st ray can be defined by two types – 1) acquired – this is due to reparative stress, mechanical pressure or tendon tightness, this will allow large amounts of dorsiflexion however minimal plantar-flexion, due to the joint sitting at its end range of motion. 2) Congenital – this develops through growth, however will allow equal motion from the plantar-flexed position, however this may still cause joint problems due to mechanical stress.

Patient will present with pain on movement, walking or running in the 1st MPJ


Diagnostic tip – holding the fifth MPJ back and slightly dorsiflexing the foot. Look across the forefoot to check for possible drop of the digit.

Testing or imagery – X-ray can check joint integrity. Visual analysis

Referrals – Podiatrist – structural assessment and biomechanical assessment to check joint integrity.

Padding and strapping can be undertaken to increase joint effectiveness. Custom made orthotics can be made will allow effective joint motion and reduce pain.

Patient Information

Summary –is a condition where the big toe joint (1st Metatarsal phalangeal joint) is dropped compared to the lesser digits. This condition can cause pain to the joint as it does not allow it to work effectively. This can cause other conditions such as Osteoarthritis, sesamoiditis or capsulitis.

How does this occur? – This is a condition which can be acquired over time due to reparative stress or biomechanical abnormality. A plantar-flexed 1st ray can also be caused by congenital birth development.

How can this be helped? – Assessment is required to establish the severity and the cause of the condition. This is undertaken by a structural and biomechanical assessment. Pressure removal is required to allow effective motion of the 1st MPJ.

Who can help? – A Podiatrist