Anatomy of the Hallux Plantar Plate and the Spectrum of Injuries: Turf Toe on Magnetic Resonance Imaging and Magnetic Resonance Arthrography

Purpose or Learning Objective: (1) To review the anatomy of the so-called plantar plate of the hallux metatarsophalangeal joint with magnetic resonance imaging (MRI) correlation; and (2) to present the spectrum of plantar plate injuries (turf toe) of the hallux as observed on MRI in seven patients.

Methods or Background: We performed an MRI-anatomical correlation of the hallux MTP in five cadaveric specimens. The specimens were sliced in three planes and photographed. The photographs were correlated with the MR images at the same level.

We obtained MR images of plantar plate tears of the hallux from three institutions in seven patients. Two experienced musculoskeletal radiologists reviewed the images and performed a systematic analysis of all components of the hallux plantar plate.

Results or Findings: The plantar plate of the hallux is a misnomer. A better term would be sesamo-ligamentous complex because there is no meniscoid-like structure as in the lesser toes. The main components are the sesamoids, sesamophalangeal, sesamometatarsal, and intersesamoid ligaments, and adjacent muscles.

The spectrum of injuries is fascinating and includes sesamoid fractures and dislocations, sesamophalangeal and sesamometatarsal tears, intersesamoid tears, flexor hallucis brevis, and adductor hallucis tears. Displacement of fractured and nonfractured sesamoids may be significant.

With magnetic resonance arthrography, peculiar contrast leakage patterns are observed due to the ruptured capsuloligamentous structures.

Conclusion: The anatomy of the hallux plantar plate is more complex compared with the lesser toes, and sesamo-ligamentous complex may be a better term. The spectrum of plantar plate injury (turf toe) is broad and may involve any of the structures of this sesamo-ligamentous complex.

Publication History

Article published online:
26 May 2023