title: Anatomic relationship of the proximal nail matrix to the extensor hallucis longus tendon insertion.
abstract: BACKGROUND
  The purpose of this study was to delineate the relationship of the terminal extensor hallucis longus tendon insertion to the proximal limit of the nail matrix of the great toe.
  
  
  METHODS
  Fifty fresh-frozen human cadaver great toes with no evidence of trauma (average age, 62.5 years; 29 males and 21 females) were used for this study. Under 25X magnification, the proximal limit of the nail matrix and the terminal bony insertion of the extensor hallucis longus tendons were identified. The distance from the terminal tendon insertion to the nail matrix was ascertained using precision calipers, an optical microscope, and autocad(®) software for windows. Twenty-five great toes were placed in a neutral formalin solution and further analysed by histological longitudinal-sections. The specimens were stained with haematoxylin and eosin and examined microscopically to determine the presence of the extensor hallucis longus tendon along the dorsal aspect of the distal phalanx of each great toe.
  
  
  RESULTS
  The main result we found in great toes was that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx in all, 100%, specimens. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of the distal phalanx as is the case for fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone.
  
  
  CONCLUSIONS
  We have found that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of distal phalanx as is the case in fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone. Our anatomic study demonstrates that the proximal limit of the matrix and nail bed of the human great toe are dorsal and overlapping the terminal extensor hallucis longus tendon until its distal bony insertion in all specimens.
authors: Centro Universitario de Plasencia, Universidad de Extremadura, Plasencia, Spain.
authors: P
authors: P
authors: Palomo López
authors: Facultad de Enfermería, Fisioterapia y Podologıa, Universidad Complutense de Madrid, Madrid, Spain.
authors: R
authors: R
authors: Becerro de Bengoa Vallejo
authors: Departamento de Ciencias de la Salud, Universidad de A Coruña, Ferrol, Spain.
authors: D
authors: D
authors: López López
authors: Facultad Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.
authors: J C
authors: JC
authors: Prados Frutos
authors: Departamento Anatomía y Embriología Humana I. Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors: J
authors: J
authors: Alfonso Murillo González
authors: Facultad Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.
authors: M E
authors: ME
authors: Losa Iglesias
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006214:Hallux / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000033:anatomy & histology*; D013710:Tendons / Q000033:anatomy & histology*; D050277:Toe Phalanges / Q000033:anatomy & histology*