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Plantar Plate Injury (Turf Toe)
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Anatomy
The first MTPJ integrity is related primarily to the joint capsule, collateral capsular ligaments, and the flexor-tendon complexes coursing on either side. The soft tissues stabilise the joint allowing for approximately 50ยฐ of dorxiflexion and 30ยฐ of plantarflexion.
- Medial and lateral collateral capsular ligaments - provide valgus and varus stability.
- Medial flexor-tendon complex - comprised of the medial head of FHB and abductor hallucis, which envelops the medial sesamoid and attaches to the medial proximal phalanx.
- Lateral flexor-tendon complex - comprised of the lateral head of FHB and adductor hallucis, which envelops the lateral sesamoid and attaches to the lateral proximal phalanx.
- Sesamoids - fulcrums that increase the lever arm of the FHB tendons and increase the plantar strength of the first MTPJ.
- Flexor hallucis longus (FHL) - the tendon is in a separate sheath between the sesamoids and inserts on the distal phalanx.
- Plantar plate - fibrocartilaginous structure which is made up of the thickened plantar joint capsule, and medial and lateral flexor-tendon complexes. It courses from the first metatarsal head and attaches to the proximal phalanx.