Metatarsophalangeal Joint Instability of the Lesser Toes and Plantar Plate Deficiency

Abstract

Our understanding of lesser toe metatarsophalangeal joint instability has increased substantially over the past few decades. Some recent articles on the subject have provided detailed anatomic descriptions that help to characterize the primary stabilizing structures of the joint. Some surgeons now advocate the incorporation of a primary repair of the plantar plate into the surgical plan for correction of metatarsophalangeal joint deviation in the sagittal and transverse planes. New surgical techniques have been developed to expose, inspect, and reliably repair the plantar plate, if necessary. Dorsal and plantar approaches have both been used successfully to repair the plantar plate. Tears of the plantar plate can be repaired primarily or advanced on the base of the proximal phalanx through bone tunnels. Outcomes of these procedures are promising, with improvements in pain and function reported along with sustained deformity correction.

Віддалені результати застосування остеотомії за L.S. Weil при хірургічному лікуванні метатарзалгії

“…МКХ-10 класифікує М як ентезопатію в блоці М70-М79 (Інші захворювання м'яких тканин): М77.4 -метатарзалгія. Вважається, що передумовою для виникнення больового синдрому є тривале циклічне перевантаження плантарної пластинки капсули плеснофалангового суглоба (ПлФС) із розвитком у ній дегенеративних змін [2]. М може зустрічатись ізольовано, однак найчастіше її прояви спостерігають у пацієнтів із hallux valgus.…”

Technique Tip

“…[1][2][3][4] The diagnosis of MTP joint instability can be demonstrated with a positive dorsal drawer's test 5 and paper pull-out test. 6 " surgical option for MTP joint instability, with the advantage of directly addressing the pathology.…”

Correction of Crossover Toe Deformity by Arthroscopically Assisted Plantar Plate Tenodesis

“…Concomitant procedures, for example, periarticular soft tissue release, extensor tendon lengthening, and Weil metatarsal osteotomy, can be performed together with repair of the plantar plate through the same dorsal incision. 3,[8][9][10][11][12][13] Nevertheless, the dorsal approach often relies on complex instrumentation and it can only provide a limited view of the involved structures. 2,3,[8][9][10][11][12][13] Plantar plate tenodesis has been described to correct the claw toe deformity by stabilizing the attenuated plantar plate through suturing the plantar plate with the extensor tendon.…”

“…3,[8][9][10][11][12][13] Nevertheless, the dorsal approach often relies on complex instrumentation and it can only provide a limited view of the involved structures. 2,3,[8][9][10][11][12][13] Plantar plate tenodesis has been described to correct the claw toe deformity by stabilizing the attenuated plantar plate through suturing the plantar plate with the extensor tendon. [14][15][16] This can be performed under arthroscopic assistance, which can provide adequate visualization even without metatarsal osteotomy.…”

“…5 Tears of the plantar plate can be treated by primary repair with or without the use of suture anchor or distal advancement of the plate to the base of the proximal phalanx through bone tunnels. 8 It can be performed through the plantar 2,7 or dorsal 3,[8][9][10][11][12][13][14][15][16][17] approaches. The plantar approach can reach the plantar plate directly.…”