Plantar plate, Plantar fascia and the transverse tie bar system.

mike weber · Sep 19, 2011

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Pathological anatomy and dynamic effect of the displaced plantar plate and the importance of the integrity of the plantar plate-deep transverse metatarsal ligament tie-bar

Found this today - really nice article which explains a lot of the concepts we have discussed here re windlass, negative windlass, increased dorsiflexion stiffness at the MTPJ´s etc and gives an explanation to toe deformity development

Hope you enjoy.

mike weber · Sep 19, 2011

For a more detailed look at the Anatomy involved

Plantar aponeurosis and internal architecture of the ball of the foot*
FINN BOJSEN-M0LLER AND K. E. FLAGSTAD

Kevin Kirby · Sep 19, 2011

mike weber said: ↑

Pathological anatomy and dynamic effect of the displaced plantar plate and the importance of the integrity of the plantar plate-deep transverse metatarsal ligament tie-bar

Found this today - really nice article which explains a lot of the concepts we have discussed here re windlass, negative windlass, increased dorsiflexion stiffness at the MTPJ´s etc and gives an explanation to toe deformity development

Hope you enjoy.
Click to expand...

Mike:

Thanks for this paper. I like the drawings and photographs of cadaver dissections and agree mostly with the explanations provided, including the reverse windlass. However, I would have described the mechanics of the plantar fascia/plantar plate on digital function somewhat differently.

I will add this paper to my lecture on the functions of the plantar fascia.:drinks

efuller · Sep 19, 2011

Ann R Coll Surg Engl 1997; 79: 58-68
Pathological anatomy and dynamic effect of
the displaced plantar plate and the
importance of the integrity of the plantar
plate-deep transverse metatarsal ligament
tie-bar
G D Stainsby FRCS

I agree with Kevin on the paper. Excellent anatomy. Iffy on a couple of locations of theory especially the Plunger effect of claw toes. An interesting use of the word control. If the guy knew a little physics.

It really is amazing how people keep coming back to Hicks to reconfirm his ideas. I did.

Eric

Rob Kidd · Sep 19, 2011

Hicks was a hero - a perfect example of so very often one goes back to the very sources (as they say in Rock'n'Roll) - some of the older works are still incredibly valid. To give an example. We have probably all heard of Hilton's law - but where can you actually find the original verbatim words? They were lost from science in about 1890 - and reappeared in Freddie Woods Jones' book on the hand - published about 1940!

NewsBot · Dec 17, 2014

Deep Transverse Metatarsal Ligament and Static Stability of Lesser Metatarsophalangeal Joints
A Cadaveric Study
Bibo Wang, MD; Andrew Guss, BA; Ornusa Chalayon, MD; Kent N. Bachus, PhD; Alexej Barg, MD; Charles L. Saltzman
Foot & Ankle International December 10, 2014

Background: The static support that guides motion around the lesser metatarsophalangeal joints (MTPJs) is complex. Biomechanical studies revealed important roles of both the plantar plane and collateral ligaments. Since part of the plantar plate is attached to the deep transverse metatarsal ligament (DTML), we hypothesized that the transection of the DTML in the intermetatarsal space may substantially reduce the MTPJ stability.
Methods: The second, third, and fourth MTPJ stabilities of 6 fresh-frozen human cadaveric foot specimens were measured under load control. Both dorsiflexion and dorsal subluxation conditions were tested. After the intact condition was assessed, the DTML was sequentially transected such that each MTPJ had a unilateral and then a bilateral DTML transection. Stiffness data were calculated using the loading range in each test condition. Paired Student t tests were performed to test for statistical significance (P value less than .05).
Results: In intact specimens, the mean stiffness with dorsiflexion of the second, third, and fourth toes was 0.52 ± 0.15 N/deg. When the DTML was operatively transected on one side, the dorsiflexion stiffness significantly decreased 17.3% to an average of 0.43 ± 1.00 N/deg (P < .001). Subsequent transection of the DTML on the other side of each joint resulted in a further significant decrease of 5.8% to an average of 0.40 ± 0.08 N/deg (P < .001). The mean stiffness with dorsal subluxation of the intact second, third, and fourth toes was 3.55 ± 0.66 N/mm. When the DTML was operatively transected on one side, the dorsal subluxation stiffness significantly decreased 16.1% to an average of 2.98 ± 0.64 N/mm (P < .001). Subsequent transection of the DTML on the other side of each joint resulted in a further significance decrease of 7.6% to an average of 2.71 ± 0.48 N/mm (P = .016).
Conclusion: The DTML has a significant role in maintaining lesser MTPJ ligament stability. Both unilateral and bilateral DTML transections caused substantial instability of the lesser MTPJ.
Clinical Relevance: The DTML is part of the natural static restraint to dorsiflexion or dorsal subluxation of the lesser MTPJ. Operative transection, injury, or degeneration of this ligament may predispose the adjacent MTPJ to instability.
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NewsBot · Mar 9, 2016

Tensile Properties of the Deep Transverse Metatarsal Ligament in Hallux Valgus: A CONSORT-Compliant Article
Abdalbary, Sahar Ahmed PhD; Elshaarawy, Ehab A.A.; Khalid, Bahaa E.A.
Medicine: February 2016 - Volume 95 - Issue 8 - p e2843

The deep transverse metatarsal ligament (DTML) connects the neighboring

2 metatarsal heads and is one of the stabilizers connecting the lateral sesamoid and second metatarsal head. In this study, we aimed to determine the tensile properties of the DTML in normal specimens and to compare these results with hallux valgus specimens. We hypothesized that the tensile properties of the DTML would be different between the 2 groups of specimens.

The DTML in the first interspace was dissected from 12 fresh frozen human cadaveric specimens. Six cadavers had bilateral hallux valgus and the other 6 cadavers had normal feet. The initial length (L0) and cross-sectional area (A0) of the DTML were measured using a digital caliper, and tensile tests with load failure were performed using a material testing machine.

There were significant between-groups differences in the initial length (L0) P = 0.009 and cross-sectional area (A0) of the DTML P = 0.007. There were also significant between-groups differences for maximum force (N) P = 0.004, maximum distance (mm) P = 0.005, maximum stress (N/mm2) P = 0.003, and maximum strain (%) P = 0.006.

The DTML is an anatomical structure for which the tensile properties differ in hallux valgus.
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NewsBot · May 15, 2022

Novel Ultrasound Anatomical Measurement of the Deep Transverse Metatarsal Ligament: An Intra-Rater Reliability and Inter-Rater Concordance Study
María Del Mar Ruiz-Herrera et al
J Clin Med. 2022 May 2;11(9):2553

Insufficient space below the Deep Transverse Metatarsal Ligament (DTML) could be an etiological factor for Morton's Neuroma (MN). To date, there is a lack of studies measuring the space below the DTML. For this reason, this study assesses the intra- and inter-rater concordance and reproducibility of measurements of the space below the DTML between the third and the fourth metatarsal heads (M3 and M4) using ultrasound imaging to assess and verify the reliability and reproducibility of measurements of the space under the DTML. Forty feet from twenty patients were examined using ultrasound by three trained evaluators at two different times. The two measurements taken on each foot were: base (b)-distance between M3 and M4, and height (h)-distance between the DTML and the plantar skin surface. This was a quantitative, observational, analytical study. The concordance rate between observers for measurements of height and base were 98.5% and 99.5%, respectively. The mean area obtained of the space was 54.6 mm2 and 57.2 mm2 for both the left and right foot (p > 0.05). Reproducibility over time calculated in pre- and post-measurements showed an intraclass correlation coefficient of 1.00 (95%CI: 0.99-1.00), which leads us to conclude that the measurements are perfectly reproducible. Both measurements (height and base) of the space under the DTML, performed by ultrasound, are reliable and reproducible.
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