The Plantar Plate of the Lesser Toes: An Anatomical Study in Human Cadavers

1994 ◽  
Vol 15 (5) ◽  
pp. 276-282 ◽  
Author(s):  
Richard B. Johnston ◽  
Judith Smith ◽  
Timothy Daniels
Keyword(s):  
Metatarsophalangeal Joint ◽  
Anatomical Study ◽  
Volar Plate ◽  
Anatomic Structure ◽  
Joint Dislocation ◽  
Plantar Plate ◽  
Adjacent Structures ◽  
Fresh Frozen ◽  
Human Cadavers ◽  
Second Toe

The purpose of this study was to evaluate the anatomic structure and biochemical composition of the plantar plate of the lesser toes. Fresh frozen-human cadaveric feet were used to study 20 metatarsophalangeal and proximal interphalangeal plantar plates. The observations of foot dissections were compared with the finger volar plate. The plantar plate of the toe is a rectangular structure with a stout distal insertion and relatively flimsy proximal origin. The anatomic relationships to adjacent structures and composition are similar between the volar plates of the fingers and plantar plates of the toes. The plantar plate is known to experience extension forces that the volar plate does not experience. The weightbearing nature of the foot and forces imposed by toe-off may create chronic hyperextension of the metatarsophalangeal joint and predispose the plantar plate to attenuation or rupture, thus leading to instability of the metatarsophalangeal joint. These findings may explain in part the clinical condition of spontaneous metatarsophalangeal joint dislocation, most commonly found in the second toe.

scholarly journals Anatomic and Histological Features of the Extensor Digitorum Longus Tendon Insertion in the Proximal Nail Matrix of the Second Toe

Diagnostics ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 147 ◽  
Author(s):  
Patricia Palomo-López ◽  
Marta Elena Losa-Iglesias ◽  
Ricardo Becerro-de-Bengoa-Vallejo ◽  
David Rodríguez-Sanz ◽  
Cesar Calvo-Lobo ◽  
...  
Keyword(s):  
Extensor Digitorum Longus ◽  
Distal Phalanx ◽  
Extensor Digitorum ◽  
Histological Features ◽  
Nail Matrix ◽  
Fresh Frozen ◽  
Human Cadavers ◽  
Digital Surgery ◽  
Tendon Insertion ◽  
Second Toe

Background: Anatomic and histological landmarks of the extensor digitorum longus (EDL) tendon insertion in the proximal nail matrix may be key aspects during surgery exposure in order to avoid permanent nail deformities. Objective: The main purpose was to determine the anatomic and histological features of the EDL’s insertion to the proximal nail matrix of the second toe. Methods: A sample of fifty second toes from fresh-frozen human cadavers was included in this study. Using X25-magnification, the proximal nail matrix limits and distal EDL tendon bony insertions were anatomically and histologically detailed. Results: The second toes’ EDLs were deeply located with respect to the nail matrix and extended superficially and dorsally to the distal phalanx in all human cadavers. The second toe distal nail matrix was not attached to the dorsal part of the distal phalanx base periosteum. Conclusions: The EDL is located plantar and directly underneath to the proximal nail matrix as well as dorsally to the bone. The proximal edge of the nail matrix and bed in human cadaver second toes are placed dorsally and overlap the distal EDL insertion. These anatomic and histological features should be used as reference landmarks during digital surgery and invasive procedures.

Irreducible Metatarsophalangeal Joint Dislocation of the Lesser Toes

2013 ◽  
Vol 103 (3) ◽  
pp. 236-240
Author(s):  
Honlok Lo ◽  
Ping-Cheng Liu ◽  
Po-Chih Shen ◽  
Shen-Kai Chen ◽  
Yuh-Min Cheng ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Metatarsophalangeal Joint ◽  
Recurrent Dislocation ◽  
Metatarsal Head ◽  
Activity Level ◽  
Rare Injury ◽  
First Metatarsophalangeal Joint ◽  
Joint Dislocation ◽  
Plantar Plate ◽  
Metatarsophalangeal Joints

Irreducible metatarsophalangeal joint dislocation of the lesser toes is a rare injury. We present a 37-year-old man who was injured in a motorcycle accident and dislocated the first to third metatarsophalangeal joints and fractured the fourth metatarsal head. The left first metatarsophalangeal joint was reduced successfully through the closed method, but multiple attempts at closed reduction under local anesthesia failed to reduce the dislocated second and third metatarsophalangeal joints. We performed a dorsal incision between the second and third metatarsals, and the metatarsal heads were found to be entrapped under the plantar plate. Dislocation reduction was performed without damage to the plantar plate, and one Kirschner wire was used to fix the fourth metatarsal head fracture. The pin was removed 8 weeks after surgery, and the patient regained normal gait and returned to work and his previous physical activity level without recurrent dislocation. (J Am Podiatr Med Assoc 103(3): 236–240, 2013)

An Anatomical Study of Morton's Interdigital Neuroma: The Relationship Between the Occurring Site and the Deep Transverse Metatarsal Ligament (DTML)

2007 ◽  
Vol 28 (9) ◽  
pp. 1007-1010 ◽  
Author(s):  
J-Young Kim ◽  
Jae Hyuck Choi ◽  
Jungmin Park ◽  
Joonho Wang ◽  
Inmook Lee
Keyword(s):  
Anterior Margin ◽  
Metatarsophalangeal Joint ◽  
Anatomical Study ◽  
Causative Factor ◽  
Metatarsal Head ◽  
Digital Nerve ◽  
Fresh Frozen ◽  
The Common ◽  
The Mean ◽  
The Relationship

Background: Using clinical and cadaver studies, we examined the relationship between the location of Morton interdigital neuromas and the surrounding structures, including the deep transverse metatarsal ligament (DTML), which has been suspected as a major causative factor in neuroma formation. Methods: Seventeen fresh-frozen cadavers were evaluated to determine the relationship between the location of Morton interdigital neuromas and the DTML at two phases of the gait cycle with 60 degrees of metatarsophalangeal dorsiflexion and with 15 degrees of ankle dorsiflexion. We measured the distance from the bifurcation of the common digital nerve in the foot to the anterior margin of the DTML and also measured the length of the DTML itself. Clinically, we checked the location of the Morton interdigital neuroma and its length during surgery in 32 feet. Results: In the second and third webspace, the mean distance from the bifurcation of the common digital nerve of the foot to the anterior margin of the DTML was 16.7 mm, 15.1 mm in the mid-stance position, and 15.9 mm and 14.6 mm in the heel-off position. The length of the second and third DTML averaged 12.8 mm and 10.6 mm. Clinically, all of the cases of Morton interdigital neuroma started at the bifurcation area of the common digital nerve, and the mean neuroma length was 7.5 mm (6 to 11). Conclusions: Morton interdigital neuromas were located more distally than the DTML in both the mid-stance and the heel-off stage during walking. The main lesion was located between the metatarsal head and the metatarsophalangeal joint and more distal than the DTML, questioning previous studies suggesting that the DTML is the major causative factor in development of Morton interdigital neuroma.

Integrity of the First Metatarsophalangeal Joint: A Biomechanical Analysis

1995 ◽  
Vol 16 (6) ◽  
pp. 357-362 ◽  
Author(s):  
David Prieskorn ◽  
Stan Graves ◽  
Michael Yen ◽  
Ray John ◽  
Schultz Randy
Keyword(s):  
Soft Tissues ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Biomechanical Analysis ◽  
First Metatarsophalangeal Joint ◽  
Plantar Plate ◽  
Significant Damage ◽  
Different Types ◽  
Fresh Frozen

Five fresh-frozen cadaver feet obtained from traumatic amputations were tested during hyperdorsiflexion stress of the first metatarsophalangeal joint. Three different types of injury were observed: (1) rupture of the capsule proximal to the sesamoids, (2) rupture of the plantar plate distal to the sesamoids, and (3) rupture of the capsular structures medially, allowing a lateral swing of the sesamoids around the metatarsal head. Incomplete dislocation can be associated with significant damage to the plantar plate and other soft tissues of the foot.

Biomechanical Evaluation of Suture Configurations in Lesser Toe Plantar Plate Repairs

2018 ◽  
Vol 39 (7) ◽  
pp. 836-842 ◽  
Author(s):  
Fred T. Finney ◽  
Simon Lee ◽  
Jaron Scott ◽  
Todd A. Irwin ◽  
James R. Holmes ◽  
...  
Keyword(s):  
Proximal Phalanx ◽  
Peak Load ◽  
Biomechanical Properties ◽  
Biomechanical Analysis ◽  
Plantar Plate ◽  
Significant Difference ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Human Cadavers ◽  
Number Of Cycles

Background: Lesser toe metatarsal-phalangeal (MTP) joint instability can be a major source of pain and dysfunction. Instability occurs when there is incompetence of the plantar plate and/or collateral ligaments. Newer operative treatments focus on performing anatomic repairs of the plantar plate. The goal of this study was to compare the biomechanical properties of 3 suture configurations that may be used for plantar plate repairs. Methods: Biomechanical analysis of 27 lesser toe plantar plates from fresh frozen human cadavers was completed. The plantar plate was detached from the proximal phalanx, and suture was placed in the distal plantar plate in a horizontal mattress, luggage-tag, or Mason-Allen suture configuration. Cyclic loading followed by load-to-failure testing was performed. Results: There was a significant difference in peak load-to-failure force between constructs (mattress: 115.53 ± 15.95 N; luggage-tag 102.42 ± 19.33 N; Mason-Allen: 89.96 ± 15.78 N; P = .015). Post hoc analysis demonstrated that the mattress configuration had significantly higher load-to-failure force compared with the Mason-Allen configuration ( P = .004). There were no significant differences between the mattress and the luggage-tag configurations or the luggage-tag and the Mason-Allen configurations. There were no differences in construct stiffness, axial displacement at the time of failure, or number of cycles required to produce 2 mm of displacement. Conclusion: The mattress configuration demonstrated better peak load-to-failure force compared with the Mason-Allen configuration but was not statistically different from the luggage-tag configuration. Although not significant, the mattress configuration trended toward higher load-to-failure force compared with the luggage-tag. Clinical Relevance: The horizontal mattress stitch may be the biomechanically superior configuration in plantar plate repairs.

The Volar Distal Radioulnar Portal in Wrist Arthroscopy: An Anatomical Study

2020 ◽  
Author(s):  
Francisco J. Lucas ◽  
Vicente Carratalá ◽  
Ignacio Miranda ◽  
Cristobal Martinez-Andrade
Keyword(s):  
At Risk ◽  
Ulnar Nerve ◽  
Surgical Techniques ◽  
Anatomical Study ◽  
Neurovascular Bundle ◽  
Wrist Arthroscopy ◽  
Iatrogenic Injuries ◽  
Flexor Carpi Ulnaris ◽  
Human Cadavers ◽  
Triangular Fibrocartilage

Abstract Background Advances in wrist arthroscopy and the emergence of novel surgical techniques have created a need for new portals to the wrist. The aim of this study was to define and verify the safety of the volar distal radioulnar (VDRU) portal. Description of the Technique The VDRU portal is located ∼5 to 10 mm proximal to the proximal wrist crease, just on the ulnar edge of flexor carpi ulnaris tendon and radial to the dorsal cutaneous branch of the ulnar nerve. The ulnar styloid marks the distal point of the portal. Methods An anatomical study was performed on 12 upper extremity specimens of 6 human cadavers. Iatrogenic injuries of neurovascular structures potentially at risk were assessed, and the distance from the portal to these structures was measured. Results No iatrogenic injuries of the structures at risk occurred. Mean distances from the VDRU portal to the ulnar neurovascular bundle, the radial branch of the dorsal sensory branches of the ulnar nerve (DSBUN), and the ulnar branch of the DSBUN were 9.29 ± 0.26 mm, 8.08 ± 0.25 mm, and 10.58 ± 0.23 mm, respectively. There were no differences between left and right wrists. The distances from the VDRU portal to the ulnar neurovascular bundle and the ulnar branch of the DSBUN were significantly shorter in women; this distance was not less than 7 mm in any case. Conclusions The VDRU portal is safe, reproducible, and facilitates the implementation of various techniques related to triangular fibrocartilage complex pathology.

scholarly journals Mediastinal anatomical landmarks, their variants and tips for video-assisted thoracoscopic navigation during oesophageal extirpation

2021 ◽  
Author(s):  
Sergey Dydykin ◽  
Friedrich Paulsen ◽  
Tatyana Khorobykh ◽  
Natalya Mishchenko ◽  
Marina Kapitonova ◽  
...  
Keyword(s):  
Prone Position ◽  
Anatomical Study ◽  
Structural Features ◽  
Posterior Mediastinum ◽  
Visual Navigation ◽  
Anatomical Landmarks ◽  
Video Assisted ◽  
Before And After ◽  
Human Cadavers ◽  
The Right

Abstract Purpose There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum’s fat tissue spaces near large vessels and nerves during video-assisted endothoracoscopic interventions in the prone position of a patient. Our aim was to develop an algorithm of sequential visual navigation during thoracoscopic extirpation of the esophagus and determine the most permanent topographic and anatomical landmarks allowing safe thoracoscopic dissection of the esophagus in the prone position. Methods The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity. Results For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura. Conclusion The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.

scholarly journals First Lumbrical Muscle Flap for Recurrence of Carpal Tunnel Syndrome: Anatomical Study and Surgical Technique

2021 ◽  
Vol 49 (01) ◽  
pp. 079-087
Author(s):  
Esther Fernández Tormos ◽  
Fernando Corella Montoya ◽  
Blanca Del Campo Cereceda ◽  
Montserrat Ocampos Hernández ◽  
Teresa Vázquez Osorio ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Revision Surgery ◽  
Muscle Flap ◽  
Anatomical Study ◽  
Physical Barrier ◽  
Adjacent Structures ◽  
Tunnel Syndrome ◽  
Lumbrical Muscle

AbstractRecurrence of carpal tunnel syndrome implies the reappearance of symptoms after release surgery. If the cause of recurrence is not an incomplete release, but a traction neuritis, the tendency is to add to the revision surgery of the carpal tunnel the use of flaps to cover the median nerve. These flaps establish a physical barrier between the nerve and the rest of the adjacent structures, preventing adhesions, and providing neovascularization and better nerve sliding.In the present work, we detail a revision surgery in which the first lumbrical muscle is used as a covering flap. This flap has two benefits. Firstly, it acts as a vascularized coverage for the median nerve (avoiding the formation of fibrosis and favoring its sliding); secondly, a structure that takes up space is removed from the carpal tunnel, thus reducing the pressure within it.Along with the explanation of the technique, the present article provides a detailed description of the anatomical variability of the first lumbrical muscle and its vascularization, as well as the results of a cadaveric study on the location of the vascular pedicle of the first lumbrical muscle.

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