Folia Morphol (Warsz). 2025 Oct 21. doi: 10.5603/fm.108234. Online ahead of print.
ABSTRACT
BACKGROUND: Given the conflicting reports in the world literature on the presence of ligaments in the distal phalanx of foot, the aim of our study was to confirm or deny the existence of ligamentous structures in this region. Confirmation of the existence of ligamentous structures is clinically important, due to the numerous pathological lesions observed in the lateral regions of the distal phalanges of foot, such as exostoses and osteophytes, which can cause discomfort to patients.
MATERIALS AND METHODS: The study was carried out on ten feet, five from men and five from women, taken from fresh frozen human cadavers. The ages of the deceased ranged from 53to 94 years, with a mean age of 75.3 years. The analysis included distal phalanges of foot, comprising 10 distal phalanges of the hallux and 10 distal phalanges each of toes II-V (a total of 50 samples). To access the deep structures of the distal phalanx of foot, a 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: As a result of the study, 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 originate from the medial and lateral aspects of the phalangeal base and extend toward the proximal portion of the medial and lateral aspects of the phalangeal head, respectively. The observed ligaments were not connected to the other ligamentous structures of the phalanges, particularly the collateral interphalangeal ligaments. Histological analysis confirmed a structure characteristic of ligamentous tissue. Hyalinisation was observed at the attachment points and along the course of the bands, which may be indicative of degenerative changes in ligaments (enthesopathies).
CONCLUSIONS: The description and confirmation of the existence of medial and lateral collateral ligaments of the distal phalanx of foot redefines the classification of lesions occurring along their course from exostoses to enthesopathies. This has direct implications for both the prevention and treatment of such lesions. Further research is needed to clarify the role of these ligaments in toe mechanics.
PMID:41117081 | DOI:10.5603/fm.108234
