Macroscopic and histological analysis of the medial and lateral collateral ligaments of the distal phalanges of the foot
Year: 2025
Type: article
Abstract: BACKGROUND: Given the conflicting reports in the literature regarding the presence of ligaments in the distal phalanx of the foot, this study aimed to verify the existence of ligamentous structures in this region. Confirmation of these structures is clinically important because numerous pathological lesions have been reported in the lateral regions of the distal phalanges, such as exostoses and osteophytes, which may cause discomfort to patients. MATERIALS AND METHODS: The study was conducted on 10 feet (5 from male and 5 from female donors) obtained from fresh-frozen human cadavers. The donors' ages ranged from 53 to 94 years (mean: 75.3 years). The analysis included distal phalanges of the hallux and toes II-V, yielding a total of 50 samples. To expose the deep structures of the distal phalanx of the foot, micro-layer resection of the nail fold tissues and the structures located along the lateral aspects of the distal phalanx was performed. Macrophotographic documentation was obtained using a Dino-Lite AM4113T digital microscope. Histological specimens were prepared from the dissected ligaments and stained using Van Gieson's method and haematoxylin and eosin (H&E). The samples were analysed using a Leica DM2000 LED microscope (Leica Microsystems CMS GmbH) and a ScanScope CS histology scanner (Aperio Technologies). RESULTS: Connective tissue bands were identified in all analysed phalanges, located in the medial and lateral regions of the distal phalanges of the hallux and toes II-V. These bands originated from the medial and lateral aspects of the phalangeal base and extended towards the proximal portion of the medial and lateral aspects of the phalangeal head, respectively. The observed ligaments were independent of other ligamentous structures of the phalanges, particularly the collateral interphalangeal ligaments. Histological analysis confirmed the structural characteristics of ligamentous tissue. Hyalinisation was observed at the attachment points and along the course of the bands, suggesting degenerative changes consistent with enthesopathies. CONCLUSIONS: The description and confirmation of the medial and lateral collateral ligaments of the distal phalanx of the foot redefine the classification of lesions occurring along their course - from exostoses to enthesopathies. These findings have direct implications for the prevention and treatment of such lesions. Further research is needed to clarify the role of these ligaments in toe biomechanics.
Source: Folia Morphologica
DOI: 10.5603/fm.108234
Language: English
Topic: Foot and Ankle Surgery
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415384606
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