The Plantar Plate of the First Metatarsophalangeal Joint

Abstract

The plantar plate of the first metatarsophalangeal (MP) joint is a critical structure of the forefoot that has been identified as a major stabilizer within the capsuloligamentous complex. Many studies have clarified and documented the anatomy of the lesser toe MP plantar plates, but few have looked closely at the anatomy of the first MP joint. Ten cadaveric specimens were examined to identify and document the objective anatomic relationship of the plantar plate, tibial sesamoid, and surrounding osseus structures. The average distance of the plantar plate distal insertion from the joint line into the proximal phalanx was 0.33 mm. The plantar plate was inserted into the metatarsal head on average 17.29 mm proximal from the joint line. The proximal aspect of the sesamoid was 18.55 mm proximal to the distal attachment of the plantar plate to the phalanx. The distal aspect of the sesamoid averaged 4.69 mm away from the distal attachment into the proximal phalanx. The footprint of the distal plate insertion was on average 6.33 mm in length in the sagittal plane. The authors hope that these objective data measures can aid in the understanding and subsequent surgical repair of this important forefoot structure.

First metatarsophalangeal joint- MRI findings in asymptomatic volunteers

“…Normal findings on clinical examination and medical imaging of the plantar plate and periarticular structures of the first metatarsophalangeal joint have recently attracted increased interest among orthopaedic foot surgeons [16][17][18][19]. Approximately 50 % of the body weight transmits through the first MTP joint during gait, and may reach eight times the body weight during running and jumping.…”

“…The plantar plate of the first MTPJ has been identified as an integral component of the capsuloligamentous complex. Thus the plantar plate provides stability to the first MTPJ, and consequently, injuries to the plantar plate and capsuloligamentous complex may result in functional disability [16][17][18][19].…”

“…We observed a distal central recess, with a mean depth of 2.2 mm, in 77 % of cases. One might speculate that the high frequency of a distal central recess of the plantar plate might be diagnostically challenging in cases of patients referred for diagnostic imaging of dorsiflexion injuries of the capsuloligamentous complex of the first MTPJ, the so-called turf toe [1,[17][18][19][28][29][30]. Theumann et al found that the plantar plate of the first MTPJ was biconcave due to the embedded sesamoid bones and crista of the metatarsal head, as well as the flexor hallucis longus tendon in the middle, between the medial and lateral heads of the flexor hallucis brevis tendons.…”

Turf Toe Injury: A Pictorial Review and a Didactic Case Report

“…They are thinner compared with the SPLs, and on imaging, they are often difficult to differentiate from the adjacent tendons and capsule. 5…”

Assessment and Management of Atraumatic First Metatarsophalangeal Joint Pain

“…The medial or tibial sesamoid is generally larger and more ovoid in shape, whereas the lateral fibular is smaller, rounder, and located more proximally. 6 They have multiple ossification centers; these centers typically begin to ossify around the age of 8 years. 7 Bi or multipartite sesamoids can result from the failure of two or more ossification centers to coalesce.…”