Background: Anatomical dissection of the second metatarsophalangeal (MTP) joint suggests that the plantar plate is the major stabilizing structure of the joint due to its central location and multiple important attachments. Many surgical procedures have been recommended when conservative treatment has failed, but some have had limited clinical success. The aim of our prospective study was to show the results obtained in the treatment of a group of patients with plantar plate tears by direct repair through a dorsal approach combined with a Weil metatarsal osteotomy with a minimum followup of 12 months. Methods We prospectively treated 28 patients (55 MTP joints) with lesser MTP joint instability, but only 22 patients (40 MTP joints) were treated by the direct repair of the plantar plate and were included in the study. All of them had initial complaints of acute forefoot pain with the subsequent development of deformity and instability of the MTP joints. All patients were evaluated clinically, radiographically, (plain radiographs and MRI exam), and by MTP joint arthroscopy. With this data, a direct correlation between the clinical staging and the anatomical grading for plantar plate dysfunction of each patient was determined Results The plantar plate of the second MTP joint was the most commonly affected joint (63%), and Grade III type tear (transverse and/or longitudinal extension tear) was the most frequent type. With the surgical treatment, we were able to markedly improve the parameters studied (pain, medial or dorsomedial deviation of the toe, joint stability, muscle balance, and joint congruence) to acceptable levels, The AOFAS score improved substantially from an average of 52 points preoperatively to 92 points postoperatively. Conclusion The direct plantar plate repair combined with a Weil osteotomy and lateral soft tissue reefing can restore the normal alignment of the MTP joint. We have demonstrated that the anatomic repair of the plantar plate can correct the deviation of the affected toe (medial, dorsal, dorsomedial or dorsolateral), which lead to diminished pain with improved functional scores. Level of Evidence: IV, Case Series

Level IV, case series.

Level II, prospective comparative study.

No abstract

BackgroundTo the present day, literature has only discussed how to treat extensive plantar plate and collateral ligament lesions, with gross joint subluxation and obvious clinical instability. The treatment options for early stages of the disease with minor injuries and subtle instabilities have not been described. The main purpose of this prospective study is to evaluate the efficacy of the combination of the arthroscopic radiofrequency shrinkage and distal Weil osteotomy in the treatment of subtle metatarsophalangeal joint instability.MethodProspective data (clinical, radiological, and arthroscopic findings) of 19 patients, with a total of 35 slightly unstable joints, was collected. The physical examination defined the hypothesis for plantar plate lesions (grades 0 and 1), which was confirmed during the diagnostic step of the arthroscopic procedure.ResultsAmong our patients, 73 % were females and 63 % reported wearing high heels. The average age was 59 years and post-operative follow-up was 20 months. In the initial sample frame, 62 % of joints showed spread-out toes with increased interdigital spacing. The mean American Orthopedic Foot and Ankle Society score rose from 53 points pre-operatively to 92 points post-operatively and a visual-analog pain scale average value of eight points pre-operatively decreased to zero post-operatively. During the pre-operative evaluation, none of the patients had stable joints and over 97 % were classified as having grade 1 instability (<50 % subluxation). After treatment, 83 % of the joints became stable (degree of instability 0) and over 97 % were congruent. All studied parameters showed statistically significant improvements in the post-operative period (p < 0.001) showing the efficiency of the treatment in pain relief, while restoring the joint stability and congruity.ConclusionArthroscopic radiofrequency shrinkage in combination with distal Weil osteotomy promotes functional improvement, pain relief, and restores the joint stability in the plantar plate lesion grades 0 and 1.