Tarsometatarsal, Intermetatarsal, Metatarsophalangeal and Interphalangeal Joints Flashcards
Tarsometatarsal joints
o In these joints, the 5 metatarsals articulate with
the 4 tarsal bones of the distal row
o Gliding joints that are NOT in a straight line
Bones of the tarsometatarsal joint
o First metatarsal – medial cuneiform
o Second metatarsal – medial cuneiform, intermediate cuneiform, lateral cuneiform
o Third metatarsal – lateral cuneiform
o Fourth metatarsal – cuboid and lateral cuneiform
o Fifth metatarsal – cuboid
Position of tarsometatarsal joints
NOT a straight line - Intermediate cuneiform and 2nd metatarsal are set posteriorly
3 joint cavities for tarsometatarsal articulations
- Medial tarsometatarsal joint
- Great tarsal joint
- Lateral tarsometatarsal joint
What bones articulate within the medial tarsometatarsal joint?
• For articulation of the kidney-shaped facets on the base of the 1st metatarsal and the anterior surface of the medial cuneiform
What bones articulate within the great tarsal joint?
- 2nd metatarsal articulates with all 3 cuneiform bones
* 3rd metatarsal articulates with lateral cuneiform
What bones articulate within the lateral tarsometatarsal joint?
- 4th metatarsal articulates with lateral cuneiform and cuboid
- 5th metatarsal articulates with cuboid
What are the three types of ligaments that form these three joint cavities?
- Dorsal
- Plantar
- Interosseous
Dorsal tarsometatarsal ligaments
- Strong, flat bands
- Usually a total of 7 ligaments
7 dorsal tarsometatarsal ligaments
- 1st (medial) dorsal tarsometatarsal ligament - Connects the 1st metatarsal and medial cuneiform
- 2nd -4th dorsal tarsometatarsal ligaments - Connect 2nd metatarsal to medial, intermediate and lateral cuneiforms
- 5th dorsal tarsometatarsal ligament - Connects the 3rd metatarsal and lateral cuneiform
- 6th dorsal tarsometatarsal ligament - Connects 4th metatarsal and cuboid - A slip of this ligament is attached
to the 3rd metatarsal - 7th dorsal tarsometatarsal ligament - Connects 5th metatarsal to cuboid
Plantar tarsometatarsal ligaments
- Plantar tarsometatarsal ligaments are weak and irregular
- Fibers course obliquely as well as longitudinally
- Variable number of ligaments (3-5)
- Ligaments of the first two metatarsals are stronger than those of the last three metatarsals
What do the plantar tarsometatarsal ligaments blend with?
- Long plantar ligament
* Tendon of tibialis posterior
5 plantar tarsometatarsal ligaments
1st and 2nd plantar tarsometatarsal ligament
• Attach proximally to the medial cuneiform
• 1st attaches distally to 1st metatarsal
• 2nd attaches distally to 2nd metatarsal
3rd plantar tarsometatarsal ligament
• Connects 3rd metatarsal to lateral cuneiform
4th plantar tarsometatarsal ligament
• Connects 4th metatarsal to cuboid
5th plantar tarsometatarsal ligament
• Connects 5th metatarsal to cuboid
3 Interosseous tarsometatarsal ligaments
- Lisfranc’s ligament
- Ligament from 2nd metatarsal to lateral cuneiform
- Ligament from 4th metatarsal to lateral cuneiform
Lisfranc’s ligament
o Connects 2nd metatarsal to medial cuneiform
o Most CONSTANT ligament
o Lies between the medial tarsometatarsal joint and the great tarsal join
What is the functional tarsometatarsal joint?
• Lisfranc’s joint is the functional tarsometatarsal joint
It refers to all 3 anatomical joints:
o Medial tarsometatarsal joint
o Lateral tarsometatarsal joint
o Great tarsal joint
Do we name each of these ligaments individually?
NOTE: although you could name each of these ligaments specifically according to the specific bones they attach to, the more general term (listed above) of “tarsometatarsal” is common
Intermetatarsal joints
- 1st and 2nd metatarsals do NOT articulate
- Bases of all other metatarsals articulate with each other
1st and 2nd metatarsals
o Bases of 1st and 2nd metatarsals do NOT articulate
o There are NO ligaments the bases of these two bones
o At times, a bursa may be located between the bases of the 1st and 2nd metatarsals
o Other times, pressure facets may be located on opposable surfaces of bases
o Sometimes a weak interosseous ligament (consisting of a few fibers) is present
All other metatarsals
o Bases of all other metatarsals articulate with each other
o Part of great tarsal joint (2nd and 3rd metatarsals, 3rd and 4th metatarsals)
o Part of lateral tarsometatarsal joint (4th and 5th metatarsal)
o NOTE: at times, the articulation between the 3rd and 4th metatarsals is part of the lateral tarsometatarsal joint instead of the great tarsal joint
Ligament support at intermetatarsal joints
3 ligaments support the articulation between two metatarsals
- Plantar intermetatarsal ligaments
- Dorsal intermetatarsal ligaments
- Interosseous intermetatarsal ligaments
Deep transverse metatarsal ligament
o The heads of all 5 metatarsal are united by the deep transverse metatarsal ligament
o The union between the heads of the 1st and 2nd metatarsals is unique to the human foot (NOT found in other primates)
o Sometimes called the “intercapitular ligament”
o Blends with the glenoid ligaments of the metatarsophalangeal joints
What separates the lumbricals from the interossei muscles?
Deep transverse metatarsal ligament
- Lumbricals pass plantarly to the ligament
- Interossei pass dorsally to the ligament
Metatarsophalangeal joints
o Metatarsophalangeal joints are ellipsoid types of synovial joints
o Rounded convex head of metatarsal articulates with concave base of a proximal phalanx
o The metatarsal heads have a trochlear-shaped surface
Action of metatarsophalangeal joints (MPJs)
o Primary action of these joints are flexion and extension
o Some abduction-adduction also occurs
Ligaments of MPJs
- Medial and lateral collateral ligaments
- Dorsal side has NO ligaments
- Plantar metatarsal phalangeal ligaments (AKA glenoid ligaments)
Medial and lateral collateral ligaments of MPJs
On the medial and lateral sides of the MPJ, the capsule thickens as the medial collateral and lateral collateral ligaments respectively
Dorsal side of MPJs
- Capsule attaches close to the articular surface of the head of the metatarsal
- Capsule is very thin here – strengthened by extensor tendons
- NO dorsal metatarsophalangeal ligaments on the dorsal side
Glenoid ligaments
Joint capsule extends back proximally on the head of the metatarsal
Plantar metatarsal phalangeal – AKA glenoid ligaments
• Blends with the fibrous capsule
• Attached loosely to the metatarsal heads, but firmly to the proximal phalanges
• Each glenoid contains a fibrocartilaginous pad
• The fibrocartilaginous pad is known as the plantar plate (plantar pad)
• Plantar plate adheres tightly to the base of the proximal phalanges and moves with them during flexion and extension
Deep transverse metatarsal ligament blends with the sides of the plantar plate
Each MPJ contains the following 4 ligaments:
- Articular capsule
- Medial collateral ligament
- Lateral collateral ligament
- Glenoid ligament
The first MPJ ONLY contains the following:
- Metatarsosesamoid ligament to medial sesamoid
- Metatarsosesamoid ligament to lateral sesamoid
- Intersesamoid ligament
- 2 sesamoidophalangeal ligaments
Flexor hallucis brevis tendons
- Flexor hallucis brevis has two tendons
- Each contains a sesamoid bone at the (MPJ of the hallux
- Ligaments attach each sesamoid to the metatarsal, phalanx and other sesamoid
Interphalangeal joints
o ALL interphalangeal joints are hinge joints (proximal and distal)
o Heads of proximal and middle phalanges (especially proximal) have pulley-shaped (trochlear) surfaces
Ligaments that each IPJ has
o Articular capsule
o Medial Collateral ligament
o Lateral collateral ligament
o Plantar interphalangeal ligament
How many IPJ joints are in each toe?
Varies by digit…
1st digit (hallux) • 2 bones (proximal and distal) • 1 interphalangeal joint
2nd, 3rd and 4th digits
• 3 bones (proximal, middle, distal)
• 2 interphalangeal joints (proximal and distal)
5th digit
• 60% of feet have 2 interphalangeal joints
• 40% of feet, have 1 interphalangeal joint
• Middle and distal phalanges are fused, so there is only 1 IPJ
