Tarsometatarsal, Intermetatarsal, Metatarsophalangeal and Interphalangeal Joints Flashcards Preview

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Flashcards in Tarsometatarsal, Intermetatarsal, Metatarsophalangeal and Interphalangeal Joints Deck (35):
1

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

2

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

3

Position of tarsometatarsal joints

NOT a straight line - Intermediate cuneiform and 2nd metatarsal are set posteriorly

4

3 joint cavities for tarsometatarsal articulations

- Medial tarsometatarsal joint
- Great tarsal joint
- Lateral tarsometatarsal joint

5

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

6

What bones articulate within the great tarsal joint?

• 2nd metatarsal articulates with all 3 cuneiform bones
• 3rd metatarsal articulates with lateral cuneiform

7

What bones articulate within the lateral tarsometatarsal joint?

• 4th metatarsal articulates with lateral cuneiform and cuboid
• 5th metatarsal articulates with cuboid

8

What are the three types of ligaments that form these three joint cavities?

- Dorsal
- Plantar
- Interosseous

9

Dorsal tarsometatarsal ligaments

- Strong, flat bands
- Usually a total of 7 ligaments

10

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

11

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

12

What do the plantar tarsometatarsal ligaments blend with?

• Long plantar ligament
• Tendon of tibialis posterior

13

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

14

3 Interosseous tarsometatarsal ligaments

- Lisfranc's ligament
- Ligament from 2nd metatarsal to lateral cuneiform
- Ligament from 4th metatarsal to lateral cuneiform

15

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

16

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

17

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

18

Intermetatarsal joints

- 1st and 2nd metatarsals do NOT articulate
- Bases of all other metatarsals articulate with each other

19

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

20

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

21

Ligament support at intermetatarsal joints

3 ligaments support the articulation between two metatarsals
- Plantar intermetatarsal ligaments
- Dorsal intermetatarsal ligaments
- Interosseous intermetatarsal ligaments

22

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

23

What separates the lumbricals from the interossei muscles?

Deep transverse metatarsal ligament
- Lumbricals pass plantarly to the ligament
- Interossei pass dorsally to the ligament

24

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

25

Action of metatarsophalangeal joints (MPJs)

o Primary action of these joints are flexion and extension
o Some abduction-adduction also occurs

26

Ligaments of MPJs

- Medial and lateral collateral ligaments
- Dorsal side has NO ligaments
- Plantar metatarsal phalangeal ligaments (AKA glenoid ligaments)

27

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

28

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

29

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

30

Each MPJ contains the following 4 ligaments:

- Articular capsule
- Medial collateral ligament
- Lateral collateral ligament
- Glenoid ligament

31

The first MPJ ONLY contains the following:

- Metatarsosesamoid ligament to medial sesamoid
- Metatarsosesamoid ligament to lateral sesamoid
- Intersesamoid ligament
- 2 sesamoidophalangeal ligaments

32

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

33

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

34

Ligaments that each IPJ has

o Articular capsule
o Medial Collateral ligament
o Lateral collateral ligament
o Plantar interphalangeal ligament

35

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