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Leung YT, Lui TH. Claw Toe With Dislocated Second Metatarsophalangeal Joint: Treated by Plantar Plate Tenodesis and Release of Collateral Ligaments. Arthrosc Tech 2022; 11:e1695-e1702. [PMID: 36311323 PMCID: PMC9596388 DOI: 10.1016/j.eats.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/07/2022] [Indexed: 02/03/2023] Open
Abstract
Claw toe deformity of the second toe is a common forefoot deformity faced by foot and ankle surgeons. Frequently, it develops as the result of plantar plate insufficiency and subsequent metatarsophalangeal (MTP) joint instability. As the disease deteriorates, the MTP joint can be dislocated. Reduction of the MTP joint without metatarsal osteotomy seems to be a logical approach unless there is excessively long second metatarsal. However, adequate periarticular soft-tissue release including the dorsal capsule, collateral ligaments and extensor tendon is needed to reduce the intra-articular pressure and minimize the risk of joint degeneration. The purpose of this Technical Note is to describe the details of plantar plate tenodesis and release of collateral ligaments for correction of claw second toe associated with dislocation of the metatarsophalangeal joint.
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Affiliation(s)
| | - Tun Hing Lui
- Address correspondence to Dr. Tun Hing Lui, M.B.B.S. (H.K.), F.R.C.S. (Edin.), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Rd., Sheung Shui, NT, Hong Kong SAR, China.
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2
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Lui TH, Chan YLC. Correction of Severe Crossover Toe Deformity By Plantar Plate Tenodesis, Arthroscopic Release of Lumbrical and Plication of Lateral Capsuloligamentous Complex. Arthrosc Tech 2021; 10:e1921-e1927. [PMID: 34401234 PMCID: PMC8355197 DOI: 10.1016/j.eats.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/16/2021] [Indexed: 02/03/2023] Open
Abstract
Plantar plate deficiency is the major cause of instability of the metatarsophalangeal joint, and plantar plate tenodesis can provide dynamic stabilization of the plantar plate. In case of crossover toe deformity, incorporation of arthroscopic release of the medial capsuloligamentous complex and the lumbrical tendon can eliminate the medial deforming force. However, in case of severe deformity, the lateral capsuloligamentous complex is attenuated. The purpose of this Technical Note is to incorporate the technique of arthroscopic plication of the lateral capsuloligamentous complex into the technique of plantar plate tenodesis and arthroscopic release of the medial capsuloligamentous complex and the lumbrical tendon.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong,Address correspondence to Tun Hing Lui, M.B.B.S. (HK), F.R.C.S. (Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
| | - Yi Lok Charis Chan
- Department of Orthopaedics and Traumatology, United Christian Hospital, Hong Kong, China
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Lui TH, Ng CK. Correction of Crossover Toe Deformity by Plantar Plate Tenodesis and Arthroscopic Release of Lumbrical. Arthrosc Tech 2021; 10:e1621-e1626. [PMID: 34258213 PMCID: PMC8252812 DOI: 10.1016/j.eats.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 02/03/2023] Open
Abstract
Plantar plate deficiency is the major cause of instability of the metatarsophalangeal joint. As the joint subluxates dorsally, the lumbrical is tethered on the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover toe deformity. Release of the lumbrical is needed to achieve adequate medial soft-tissue release. Plantar plate tenodesis has been described to correct the deformity by suturing the plantar plate to the extensor digitorum longus tendon. The purpose of this Technical Note is to incorporate the technique of arthroscopic release of the lumbrical tendon into the technique of plantar plate tenodesis.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, Hong Kong
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
| | - Chun Kiu Ng
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Tsuen Wan, Hong Kong
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Clements JR, Ghai AK. An Innovative Method for Plantar Plate Repair: Technique Guide and Case Report. J Foot Ankle Surg 2019; 58:555-561. [PMID: 30902492 DOI: 10.1053/j.jfas.2018.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Indexed: 02/03/2023]
Abstract
Disruption of the plantar plate is a common cause of forefoot pain, metatarsalgia, and metatarsophalangeal joint malalignment. Although surgical repair of the plantar plate has improved, there has been no consensus on the clinical superiority of any single technique, or combination of techniques, described in the literature to date. In this publication, we report a case of plantar plate injury treated with an innovative new technique with 20-month follow-up.
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Affiliation(s)
- J Randolph Clements
- Associate Professor, Carilion Clinic, Virginia Tech School of Medicine / Institute of Orthopaedics and Neurosciences, Roanoke, VA
| | - Ajay K Ghai
- Foot and Ankle Surgery Resident PGY-3, Carilion Clinic, Virginia Tech School of Medicine Podiatry Residency Program, Roanoke, VA.
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Lui TH, LiYeung LL. Modified double plantar plate tenodesis. Foot Ankle Surg 2017; 23:62-67. [PMID: 28159046 DOI: 10.1016/j.fas.2016.05.313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 02/25/2016] [Accepted: 05/03/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Metatarsophalangeal joint instability of the lesser toe can cause acquired toe deformity. Plantar plate deficiency is the major pathology. Plantar plate repair can stabilize the joint but may result in iatrogenic transverse plane toe deformity in correction of claw toe deformity. Limited toe extension can be resulted after correction of crossover toe deformity by plantar plate tenodesis and extensor digitorum brevis transfer. A modification of the technique is proposed. MATERIALS AND METHODS The clinical outcomes of 10 patients with the modified procedure performed were assessed. RESULTS The correction was full in all toes with no recurrence. CONCLUSION The modified technique can stabilize the metatarsophalangeal joint and correct lesser toe deformity without the need of tendon transfer, osteotomy or sophisticated instrumentation.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region.
| | - L L LiYeung
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region.
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Prissel MA, Hyer CF, Donovan JK, Quisno AL. Plantar Plate Repair Using a Direct Plantar Approach: An Outcomes Analysis. J Foot Ankle Surg 2017; 56:434-439. [PMID: 28139400 DOI: 10.1053/j.jfas.2016.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 02/03/2023]
Abstract
Direct plantar plate repair using a plantar approach has been described previously, but with few reports of the outcomes or clinical results. The purpose of the present study was to determine the outcomes of this technique. We performed a retrospective analysis of patients who had undergone direct plantar plate repair with or without concomitant Weil osteotomy and a prospective patient-reported subjective outcomes analysis. Ultimately, 131 patients (144 toes) were included, and the response rate for the mailed surveys was 53.5% (77 of 144 toes). The clinical outcomes reported a well-aligned toe in 87.1% of cases, with a recurrence rate of 7.6% (11 of 144) and a revision rate of 2.8% (4 of 144). Statistically significant improvement in the overall modified Foot Function Index (p < .001) and subscale scores for pain (p < .001), disability (p < .001), and activity limitation (p = .001) were noted postoperatively compared with the preoperative data. The median postoperative visual analog pain scale level reported at survey completion was 2.0 (range 0.0 to 10.0; mean ± standard deviation 2.3 ± 2.6). Despite the modified Foot Function Index scores, the patient satisfaction questionnaire data reported mixed results. Our modified Foot Function Index results demonstrated that this approach provides excellent postoperative pain relief, improvement of associated disability, and improvement in activity limitations. The importance of managing patient expectations is acknowledged secondary to the discrepancy with the patient satisfaction data and the modified Foot Function Index results. Further prospective study is warranted to compare this technique with alternate dorsal approaches for plantar plate repair with and without associated commercially available suture passing systems.
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Affiliation(s)
- Mark A Prissel
- Attending Physician, Orthopedic Foot and Ankle Center, Westerville, OH
| | - Christopher F Hyer
- Attending Physician and Fellowship Director, Orthopedic Foot and Ankle Center, Westerville, OH.
| | - Jacqueline K Donovan
- Resident, Medical Education Department, Postgraduate Year 3, Grant Podiatric Medicine and Surgery Residency, Columbus, OH
| | - Amanda L Quisno
- Resident, Medical Education Department, Postgraduate Year 3, Grant Podiatric Medicine and Surgery Residency, Columbus, OH
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Interdigital Neuroma in the Second Intermetatarsal Space Associated with Metatarsophalangeal Joint Instability. Case Rep Orthop 2016; 2016:9575917. [PMID: 28003923 PMCID: PMC5143741 DOI: 10.1155/2016/9575917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022] Open
Abstract
The entrapment theory is the most commonly accepted theory concerning the development of interdigital neuroma; it incriminates the deep transverse metatarsal ligament as the major causative factor of the condition. This report presents a patient with interdigital neuroma in the second intermetatarsal space, which was strongly suspected to be caused by the metatarsophalangeal joint instability due to plantar plate injury. Surgical intervention revealed that the neuroma was located more distally and dorsally than the deep transverse metatarsal ligament and was pinched between the adjacent metatarsal heads, suggesting the involvement of the metatarsophalangeal joint instability and chronic trauma as etiologies in this case.
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Lui TH. Correction of Crossover Toe Deformity by Arthroscopically Assisted Plantar Plate Tenodesis. Arthrosc Tech 2016; 5:e1273-e1279. [PMID: 28149725 PMCID: PMC5263059 DOI: 10.1016/j.eats.2016.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/20/2016] [Indexed: 02/03/2023] Open
Abstract
Plantar plate deficiency is the major pathology causing metatarsophalangeal joint instability. As the joint subluxates dorsally, the lumbrical is tethered at the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover toe deformity. Plantar plate repair or reconstruction is a logical surgical treatment option. This can be performed through a dorsal or plantar approach. The purpose of this technical note is to report a minimally invasive technique of crossover toe deformity correction by suturing the plantar plate to the extensor tendon. It is indicated for symptomatic crossover toe deformity that is not responsive to nonsurgical treatment. It is contraindicated if the metatarsophalangeal joint is degenerated, destructed, or dislocated, or there is interdigital neuroma at the sides of the deformed toe, or the deformity is caused by bony deformities of the metatarsal head or the proximal phalanx.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Donegan RJ, Caminear D. Anatomic Repair of Plantar Plate With Flexor Tendon Sheath Reinforcement: Case Series. Foot Ankle Spec 2016; 9:438-43. [PMID: 26856986 DOI: 10.1177/1938640016630057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Plantar plate pathology has gained considerable attention in recent time, and with this increased awareness multiple treatments have been proposed. There have been no comparison studies between these treatments. The authors feel a direct approach for anatomic repair allows for plantar plate repair and tightening to desired tension, without any plantar prominences or potentially irritating hardware. In addition if the plantar plate is found to be attenuated or there is a lack of residual tissue, the described imbrication utilizing the flexor digitorum longus sheath, which is not possible with hardware or newest instrumentation, allows for a robust repair. The presented case series provides results from consecutive patients treated with proposed concurrent plantar and dorsal incisions, providing proof of concept and viability of novel technique. LEVELS OF EVIDENCE Level V: Case series.
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Maas NMG, van der Grinten M, Bramer WM, Kleinrensink GJ. Metatarsophalangeal joint stability: a systematic review on the plantar plate of the lesser toes. J Foot Ankle Res 2016; 9:32. [PMID: 27547243 PMCID: PMC4992309 DOI: 10.1186/s13047-016-0165-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Instability of the metatarsophalangeal (MTP) joints of the lesser toes (digiti 2–5) is increasingly being treated by repair of the plantar plate (PP). This systematic review examines the anatomy of the plantar plate of the lesser toes, and the relation between the integrity of the plantar plates of the lesser toes and lesser MTP joint stability. Methods The databases of Embase.com, Medline (Ovid), Web of Science, Scopus, Cochrane, Pubmed not medline, Cinahl (ebsco), ProQuest, Lilacs, Scielo and Google Scholar were searched in June 2015 from inception. Studies were included if they were in English, contained primary data, and had a focus on plantar plate anatomy of the lesser toes or on the relationship between integrity of the plantar plate and MTP joint (in)stability. Study characteristics were extracted into two main tables and descriptive anatomical and histological data were summarized into one schematic 3D drawing of the plantar plate. Results Nine studies were included in this systematic review, of which five addressed plantar plate anatomy as such and four focused directly and indirectly on plantar plate integrity related to MTP joint stability. Conclusion This is the first systematic review regarding plantar plate anatomy related to MTP joint stability of the lesser toes. This review iterates the importance of plantar plate anatomy and integrity for MTP joint stability, and it delineates the lack of primary data regarding plantar plate anatomy of the lesser toes and MTP joint stability. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0165-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nico M G Maas
- Department of Neuroscience, Erasmus University Medical Centre, P.O. Box 2040, Ee-177, 3000 CA Rotterdam, The Netherlands
| | - Margot van der Grinten
- Department of Orthopaedic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience, Erasmus University Medical Centre, P.O. Box 2040, Ee-177, 3000 CA Rotterdam, The Netherlands
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Conservative Management of Second Metatarsophalangeal Joint Instability in a Professional Dancer: A Case Report. J Orthop Sports Phys Ther 2016; 46:114-23. [PMID: 26755404 DOI: 10.2519/jospt.2016.5824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Professional ballet and modern dancers spend an inordinate amount of time on demi pointe (rising onto their forefeet), placing excessive force on the metatarsophalangeal joints and putting them at risk of instability. Surgical treatment of this condition is well described in the literature. However, studies describing conservative management, particularly in dance populations, are lacking. CASE DESCRIPTION A 33-year-old dancer presented with insidious onset of medial arch and second and third metatarsophalangeal joint pain. Functional deficits included the inability to walk barefoot, perform demi relevé, or balance on demi pointe. Imaging studies revealed osteoarthritis of the first metatarsophalangeal joint, second metatarsophalangeal joint calcification, capsulitis, and plantar plate rupture, leading to a diagnosis of instability. The dancer underwent a treatment program that included taping, padding, physical therapy, a series of prolotherapy injections, and activity modification. OUTCOMES The dancer was seen for a total of 37 physical therapy sessions over the 16-week rehabilitation period. At the time of discharge, the patient had returned to full duty and performed all choreography with taping and padding. Repeated single-leg jumps and turns on the right foot, however, still caused discomfort. At her 6-month follow-up, the dancer's total Dance Functional Outcome Survey (DFOS) score had improved from 16% to 86%, and her Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) physical scores improved from 24 to 47. One year after discharge, the dancer reported pain-free dancing with no taping or padding. DISCUSSION This case report describes early diagnosis and a multimodal treatment approach in a professional dancer with significant disability secondary to metatarsophalangeal joint instability. LEVEL OF EVIDENCE Therapy, level 4.
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Irreducible fifth metatarsophalangeal joint after car crush injury. Case Rep Orthop 2015; 2015:894057. [PMID: 25861501 PMCID: PMC4377348 DOI: 10.1155/2015/894057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/02/2015] [Indexed: 11/18/2022] Open
Abstract
Metatarsophalangeal joint dislocations are uncommon injuries. Herein, an irreducible dislocation of fifth metatarsophalangeal joint with fractures on the second, third, and fourth metatarsal head was reported. Joint reduction could not be achieved which necessitated open reduction. Six months after surgery the patient was walking and doing his daily activities without any complaints. He had returned to his pretrauma functional level.
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Clement RC, Eskildsen SM, Tennant JN. Technical tip and cost analysis for lesser toe plantar plate repair with a curved suture needle. Foot Ankle Int 2015; 36:330-4. [PMID: 25367248 DOI: 10.1177/1071100714558510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- R Carter Clement
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Scott M Eskildsen
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Joshua N Tennant
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
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Sanhudo JAV. Plantar Plate Provocation Test: A Clinical Sign for Identification of Plantar Plate Lesion. Foot Ankle Spec 2014; 7:291-292. [PMID: 24962696 DOI: 10.1177/1938640014539809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Watson TS, Reid DY, Frerichs TL. Dorsal Approach for Plantar Plate Repair With Weil Osteotomy: Operative Technique. Foot Ankle Int 2014; 35:730-9. [PMID: 24850163 DOI: 10.1177/1071100714536540] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED In recent years, the role of the plantar plate in lesser metatarsophalangeal joint stability has increasingly been recognized. Tearing or attenuation of the plantar plate often will result in crossover or hammertoe deformity with hyperextension of the MTP joint. Some patients are able to have resolution of painful symptoms with conservative treatment but for those that fail these measures, surgical fixation of the plantar plate is indicated. While, there have been some described techniques for direct repair of the plantar plate, we present a surgical technique through a dorsal approach with a Weil osteotomy which accomplishes great clinical correction of the plantar plate tear and associated toe deformity as well as relief of patient's pain. Additionally, we believe this technique is safe, efficient and reproducible. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Troy S Watson
- Foot and Ankle Institute, Desert Orthopaedic Center, Las Vegas, NV, USA
| | - Dorian Y Reid
- Foot and Ankle Institute, Desert Orthopaedic Center, Las Vegas, NV, USA
| | - Timothy L Frerichs
- North Florida Sports Medicine and Orthopaedic Center, Tallahassee, FL, USA
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