What is the normal capsular pattern of the Metatarsophalangeal joints?

• A. 1st MTP: Extension > Flexion (+/-2:1); 2-5: Flexion >/= Extension
• B. Flexion > Extension for all toes
• C. Extension > Flexion for all toes
• D. No capsular pattern

Answer: (A)

Understanding capsular pattern helps you recognize how a joint injury tends to restrict motion. When the joint capsule is involved, ROM loss occurs in a characteristic order, with one direction being more limited than the opposite.

For the metatarsophalangeal joints, the big toe behaves differently from the others. The first MTP joint shows extension being more limited than flexion, often described as extension being about twice as limited as flexion. In contrast, the joints of toes two through five tend to have greater restriction in flexion than in extension.

So the normal pattern is: the first MTP has more limited extension than flexion, and toes 2–5 have more limited flexion than extension. This is why the statement describing these relative limitations is the best answer.