Metatarsophalangeal joint

Last revised by Henry Knipe on 12 Jan 2024

The metatarsophalangeal joints (MTPJ) are the articulations in the forefoot between the heads of the metatarsals and the proximal phalanges 1.

Gross anatomy

The metatarsophalangeal joint is formed by the articulation of the metatarsals with their adjacent proximal phalanges. They are condyloid synovial joints which allow for flexion, extension and limited adduction and abduction 2

First toe

The metatarsophalangeal joint of the first toe is stabilized by a capsule, ligaments and tendons. Various terms are described in the literature to describe the supporting plantar soft tissues including plantar capsuloligamentous complex, hallucal-sesmoid complex, and plantar plate complex 5.

  • plantar plate complex 5

    • hallux sesamoids: medial and lateral

    • plantar plate: unlike the plantar plates of the lesser metatarsophalangeal joints, a fibrocartilaginous pad surrounding the hallux sesamoids and blending with the other plantar plate complex structures 5

    • plantar joint capsule

    • intersesamoid ligament

    • sesamoid-phalangeal ligaments: thick ligaments from distal sesamoid to proximal phalanx base 5

    • metatarsosesamoid (suspensory) ligaments: thin ligaments from plantar metatarsal neck to inferior sesamoid 5

    • musculotendinous insertions 5

      • flexor hallucis brevis: medial tendon to proximal medial sesamoid; lateral head to plantar lateral sesamoid

      • flexor hallucis longus: tendon sheath blends with the intersesamoid ligament

      • adductor hallucis: insertion associated with lateral sesamoid

      • abductor hallucis: insertion associated with medial sesamoid

  • collateral (metatarsophalangeal) ligaments: medial and lateral

    • obliquely oriented from metatarsal condyle to the tubercle at the proximal phalanx base 5

  • extensor apparatus

    • extensor hallucis brevis (EHB): inserts into proximal phalanx base dorsally 5

    • extensor hallucis longus (EHL): passes superficial to EHB to insert onto the distal phalanx base dorsally and dorsal capsule 5

    • extensor hood: medial and lateral sagittal bands that blend with the joint capsule and anchor both EHB and EHL tendons

Lesser metatarsophalangeal joints

The lesser (second-to-fourth) metatarsophalangeal joints also have a capsuloligamentous complex which is comprised of 3:

  • fibrous capsule

  • collateral ligamentous complexes: proper and accessory

  • plantar plate: rectangular/trapezoidal fibrous disc / fibrocartilagenous thickening thickening that originates from the metatarsal shaft periosteum to the proximal phalanx 4,5

Additional supporting muscles:

Related pathology

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