Deep Transverse Metatarsal Ligaments
Description
-
![Confirmation of a complete release of the deep transverse metatarsal ligament (DTML) using fluoroscopy—left before, right after the ultrasound‐guided surgical release with widening the third intermetatarsal space[1]](/w/images/thumb/b/b3/Deep_Transverse_Metatarsal_Ligaments_release.jpeg/120px-Deep_Transverse_Metatarsal_Ligaments_release.jpeg)
Confirmation of a complete release of the deep transverse metatarsal ligament (DTML) using fluoroscopy—left before, right after the ultrasound‐guided surgical release with widening the third intermetatarsal space[1] -
![Illustrated anatomy of the foot A) The tarsal bones B) The plantar fascia C) The long plantar, short plantar and calcaneonavicular ligaments are located in the midfoot and are primarily longitudinally oriented. The deep and superficial transverse metatarsal ligaments are examples of stiff, transversally oriented elastic tissues between the metatarsals[2]](/w/images/thumb/a/ad/Foot_anatomy_Deep_Transverse_Metatarsal_Ligaments.jpeg/120px-Foot_anatomy_Deep_Transverse_Metatarsal_Ligaments.jpeg)
Illustrated anatomy of the foot A) The tarsal bones B) The plantar fascia C) The long plantar, short plantar and calcaneonavicular ligaments are located in the midfoot and are primarily longitudinally oriented. The deep and superficial transverse metatarsal ligaments are examples of stiff, transversally oriented elastic tissues between the metatarsals[2] -
![Ultrasound imaging of the measurements. C: Metatarsal heads 3 and 4 (M3 and M4). DTML: Deep transverse metatarsal ligament. h: Height: Distance between the DTML and the plantar skin in the middle area between M3 and M4. b: Base: Distance between M3 and M4[3]](/w/images/thumb/7/79/Measure_Deep_Transverse_Metatarsal_Ligaments_ultrasound.jpeg/120px-Measure_Deep_Transverse_Metatarsal_Ligaments_ultrasound.jpeg)
Ultrasound imaging of the measurements. C: Metatarsal heads 3 and 4 (M3 and M4). DTML: Deep transverse metatarsal ligament. h: Height: Distance between the DTML and the plantar skin in the middle area between M3 and M4. b: Base: Distance between M3 and M4[3] -
![Third interspace Morton's entrapment treated through transection of the intermetatarsal ligament[4]](/w/images/thumb/2/2f/Morton_neuroma_Deep_Transverse_Metatarsal_Ligaments.jpeg/67px-Morton_neuroma_Deep_Transverse_Metatarsal_Ligaments.jpeg)
Third interspace Morton's entrapment treated through transection of the intermetatarsal ligament[4] -
![(a) From medial to lateral, (b) from proximal to distal: US‐appearance of the deep transverse metatarsal ligament (DTML) in two planes[5]](/w/images/thumb/0/0a/Ultarsound_Deep_Transverse_Metatarsal_Ligaments.jpeg/120px-Ultarsound_Deep_Transverse_Metatarsal_Ligaments.jpeg)
(a) From medial to lateral, (b) from proximal to distal: US‐appearance of the deep transverse metatarsal ligament (DTML) in two planes[5]
![Confirmation of a complete release of the deep transverse metatarsal ligament (DTML) using fluoroscopy—left before, right after the ultrasound‐guided surgical release with widening the third intermetatarsal space[1]](/File:Deep_Transverse_Metatarsal_Ligaments_release.jpeg)
![Illustrated anatomy of the foot A) The tarsal bones B) The plantar fascia C) The long plantar, short plantar and calcaneonavicular ligaments are located in the midfoot and are primarily longitudinally oriented. The deep and superficial transverse metatarsal ligaments are examples of stiff, transversally oriented elastic tissues between the metatarsals[2]](/File:Foot_anatomy_Deep_Transverse_Metatarsal_Ligaments.jpeg)
![Ultrasound imaging of the measurements. C: Metatarsal heads 3 and 4 (M3 and M4). DTML: Deep transverse metatarsal ligament. h: Height: Distance between the DTML and the plantar skin in the middle area between M3 and M4. b: Base: Distance between M3 and M4[3]](/File:Measure_Deep_Transverse_Metatarsal_Ligaments_ultrasound.jpeg)
![Third interspace Morton's entrapment treated through transection of the intermetatarsal ligament[4]](/File:Morton_neuroma_Deep_Transverse_Metatarsal_Ligaments.jpeg)
![(a) From medial to lateral, (b) from proximal to distal: US‐appearance of the deep transverse metatarsal ligament (DTML) in two planes[5]](/File:Ultarsound_Deep_Transverse_Metatarsal_Ligaments.jpeg)
Names
- Deep Transverse Metatarsal Ligament
- Deep Transverse Ligaments of the Foot
- Deep Transverse Metatarsal Ligament Complex
- Transverse Metatarsal Ligaments
- Deep Transverse Plantar Ligaments
- Intermetatarsal Transverse Ligaments
- Deep Intermetatarsal Ligaments
General
- Fibrous structures that connect adjacent metatarsal heads in the forefoot
- Responsible for stabilizing the Intermetatarsal Joints
- Present between the second to fifth metatarsals
- Can be oriented longitudinal, oblique or transverse
- Considerable variability between individuals
Description
- They form a transverse band that prevents excessive splaying of the metatarsals[7]
- Typically measures 10-13 mm in length in the second and third intermetatarsal space
- Lie dorsal to the common plantar digital nerves
- Create a plantar intermetatarsal tunnel through which neurovascular structures pass<Ref>Wei, Baofu, et al. "Anatomy of the Plantar Intermetatarsal Tunnel: A Cadaveric Study." The Journal of Foot and Ankle Surgery 62.2 (2023): 323-326./ref>
Function
- Provides significant static stability to the lesser metatarsophalangeal (MTP) joints
- Cadaveric studies demonstrate that unilateral DTML transection reduces dorsiflexion stiffness by 17% and dorsal subluxation stiffness by 16%
- Highlights the ligament's role in preventing dorsal subluxation and maintaining joint stability
Clinical Significance
- Lisfranc Fracture
- Metatarsal Fracture
- Fifth Metatarsal Fracture
- Metatarsal Stress Fracture
- Mortons Neuroma
- Hallux Valgus
- MTP Joint Instability and Dislocation
See Also
References
- ↑ Nieves, Gabriel Camunas, et al. "Anatomic basis for a new ultrasound‐guided, mini‐invasive technique for release of the deep transverse metatarsal ligament." Clinical Anatomy 34.5 (2021): 678-684.
- ↑ Venkadesan, Madhusudhan, et al. "Stiffness of the human foot and evolution of the transverse arch." Nature 579.7797 (2020): 97-100.
- ↑ del Mar Ruiz-Herrera, María, et al. "Novel ultrasound anatomical measurement of the deep transverse metatarsal ligament: an Intra-Rater reliability and Inter-Rater concordance study." Journal of Clinical Medicine 11.9 (2022): 2553.
- ↑ Stephen L, Barrett, et al. "Endocsopic Decompression of Intermetatarsal Nerve (EDIN) for the Treatment of Morton’s Entrapment—Multicenter Retrospective Review." Open Journal of Orthopedics 2012 (2012).
- ↑ Nieves, Gabriel Camunas, et al. "Anatomic basis for a new ultrasound‐guided, mini‐invasive technique for release of the deep transverse metatarsal ligament." Clinical Anatomy 34.5 (2021): 678-684.
- ↑ Sarpong, Nana O., et al. "Metatarsal fractures." Foot & Ankle Orthopaedics 3.3 (2018): 2473011418775094.
- ↑ Wang, Bibo, et al. "Deep transverse metatarsal ligament and static stability of lesser metatarsophalangeal joints: a cadaveric study." Foot & ankle international 36.5 (2015): 573-578.