3 Treatment of Plantar Plate Tears of the Lesser Metatarsophalangeal Joints

2018 ◽  
Keyword(s):  
Plantar Plate ◽  
Metatarsophalangeal Joints

Static Versus Dynamic Musculoskeletal Ultrasound for Detection of Plantar Plate Pathology

2014 ◽  
Vol 7 (4) ◽  
pp. 259-265 ◽  
Author(s):  
Catherine A. Feuerstein ◽  
Lowell Weil ◽  
Lowell Scott Weil ◽  
Erin E. Klein ◽  
Adam Fleischer ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Dynamic Assessment ◽  
Musculoskeletal Ultrasound ◽  
Plantar Plate ◽  
Dynamic Ultrasound ◽  
Static Versus Dynamic ◽  
Sensitivity Specificity ◽  
Metatarsophalangeal Joints

Musculoskeletal ultrasound (US) is a common modality used to examine plantar plate pathology. Comparison of the diagnostic accuracy of static versus dynamic ultrasound has not been previously published. The objective of this study was to prospectively compare the value of using preoperative static and dynamic ultrasound findings to diagnose plantar plate pathology using intraoperative inspection as the standard of reference. Patients attending a single foot and ankle specialty clinic from August 2012 to June 2013 with clinically suspected plantar plate pathology that was unresponsive to conservative care served as the study population. Static and dynamic ultrasound exams were performed by a single experienced rater and compared to intraoperative findings. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value were determined for static and dynamic ultrasound exams. Thirty-six patients (45 lesser metatarsophalangeal joints) were included in this analysis. Of the 36 patients, 29 were females and 7 were males with average age of 57.9 ± 7.8 years (range, 38-73). There were 38 plantar plate tears (84.4%) noted on intraoperative examination. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for the static US exam were 80.0%, 81.6%, 71.4%, 93.9%, and 41.7%, respectively. The same values for the dynamic US exam were 88.9%, 100%, 28.6%, 88.3%, and 100%, respectively. Static and dynamic ultrasound techniques are each highly sensitive methods for assessing plantar plate pathology. However, the sensitivity and accuracy of the exam is best when dynamic assessment of the plantar plate is employed. Caution should be used when relying solely on static images to diagnose subtle injuries in this area of the foot. Levels of Evidence: Diagnostic Level II, Prospective

Irreducible Metatarsophalangeal Joint Dislocation of the Lesser Toes

2013 ◽  
Vol 103 (3) ◽  
pp. 236-240
Author(s):  
Honlok Lo ◽  
Ping-Cheng Liu ◽  
Po-Chih Shen ◽  
Shen-Kai Chen ◽  
Yuh-Min Cheng ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Metatarsophalangeal Joint ◽  
Recurrent Dislocation ◽  
Metatarsal Head ◽  
Activity Level ◽  
Rare Injury ◽  
First Metatarsophalangeal Joint ◽  
Joint Dislocation ◽  
Plantar Plate ◽  
Metatarsophalangeal Joints

Irreducible metatarsophalangeal joint dislocation of the lesser toes is a rare injury. We present a 37-year-old man who was injured in a motorcycle accident and dislocated the first to third metatarsophalangeal joints and fractured the fourth metatarsal head. The left first metatarsophalangeal joint was reduced successfully through the closed method, but multiple attempts at closed reduction under local anesthesia failed to reduce the dislocated second and third metatarsophalangeal joints. We performed a dorsal incision between the second and third metatarsals, and the metatarsal heads were found to be entrapped under the plantar plate. Dislocation reduction was performed without damage to the plantar plate, and one Kirschner wire was used to fix the fourth metatarsal head fracture. The pin was removed 8 weeks after surgery, and the patient regained normal gait and returned to work and his previous physical activity level without recurrent dislocation. (J Am Podiatr Med Assoc 103(3): 236–240, 2013)

scholarly journals Presence of Neovascularization in Torn Plantar Plates of the Lesser Metatarsophalangeal Joints

2021 ◽  
pp. 107110072199003
Author(s):  
Natalie V. Singer ◽  
Noah E. Saunders ◽  
James R. Holmes ◽  
David M. Walton ◽  
Fred T. Finney ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Proximal Phalanx ◽  
Surgical Techniques ◽  
Phosphomolybdic Acid ◽  
Ct Imaging ◽  
Control Group ◽  
Vascular Density ◽  
Computed Tomographic ◽  
Plantar Plate ◽  
Metatarsophalangeal Joints

Background: Recent surgical techniques have focused on anatomic repair of lesser toe metatarsophalangeal (MTP) plantar plate tears, yet it remains unknown whether the plantar plate has the biological capacity to heal these repairs. Therefore, a better understanding of the plantar plate vasculature in response to injury may provide further insight into the potential for healing after anatomic plantar plate repair. Recently, a study demonstrated that the microvasculature of the normal plantar plate is densest at the proximal and distal attachments. The purpose of this study was to compare the intact plantar plate microvasculature network to the microvasculature network of plantar plates in the presence of toe deformity using similar perfusion and nano–computed tomographic (CT) imaging methods. Methods: Seven fresh-frozen human cadaveric lower extremities with lesser toe deformities including hammertoe or crossover toe were perfused using a barium solution. The soft tissues of each foot were counterstained with phosphomolybdic acid (PMA). Then using nano-CT imaging, the second through fourth toe metatarsophalangeal joints of 7 feet were imaged. These images were then reconstructed, plantar plate tears were identified, and 11 toes remained. The plantar plate microvasculature for these 11 toes was analyzed, and calculation of vascular density along the plantar plate was performed. Using analysis of variance (ANOVA), this experimental group was compared to a control group of 35 toes from cadaveric feet without deformity and the vascular density compared between quartiles of plantar plate length proximal to distal. A power analysis was performed, determining that 11 experimental toes and 35 control toes would be adequate to provide 80% power with an alpha of 0.05. Results: Significantly greater vascular density (vascular volume/tissue volume) was found along the entire length of the plantar plate for the torn plantar plates compared to intact plantar plates (ANOVA, P < .001). For the first quartile of length (proximal to distal), the vascular density for the torn plantar plates was 0.365 (SD 0.058) compared to 0.281 (SD 0.036) for intact plantar plates; in the second quartile it was 0.300 (SD 0.044) vs 0.175 (SD 0.025); third quartile it was 0.326 (SD 0.051) vs 0.117 (SD 0.015); and fourth (most distal) quartile was 0.600 (SD 0.183) vs 0.319 (SD 0.082). Conclusion: Torn plantar plates showed increased vascular density throughout the length of the plantar plate with an increase in density most notable in the region at or just proximal to the attachment to the proximal phalanx. Our analysis revealed that torn plantar plates exhibit neovascularization around the site of a plantar plate tear that does not exist in normal plantar plates. Clinical Relevance: The clinical significance of the increased vascularity of torn plantar plates is unknown at this time. However, the increase in vasculature may suggest that the plantar plate is a structure that is attempting to heal.

Technique and Tips for Multiplanar Correction of Plantar Plate Repairs in Lesser Metatarsophalangeal Joints

2019 ◽  
Vol 109 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Brant L. McCartan ◽  
Christopher A. Juels ◽  
Jonathan A. Shih
Keyword(s):  
Operative Time ◽  
Metatarsal Osteotomy ◽  
Dorsal Approach ◽  
Interference Screws ◽  
Repair Technique ◽  
Plantar Plate ◽  
Improved Technique ◽  
Metatarsophalangeal Joints ◽  
Improve Patient

Plantar plate repairs are challenging procedures because of the small anatomy of the plantar plate. This can make them daunting, time-consuming procedures to perform. Advances in technology, such as interference screws and small suture passers, have created improved technique possibilities to decrease difficulty, correct multiple planes of deformity, create stronger constructs, and improve patient results. The plantar plate repair technique presented in this article includes a dorsal approach with a metatarsal osteotomy, a knotless repair that provides a strong construct to allow patients to protectively bear weight immediately, and can reduce operative time by presenting tips to quickly navigate the procedure. The presented technique allows for detailed correction of all three planes of deformity, maximizing patient results.

Role of Plantar Plate and Surgical Reconstruction Techniques on Static Stability of Lesser Metatarsophalangeal Joints

2013 ◽  
Vol 34 (10) ◽  
pp. 1436-1442 ◽  
Author(s):  
Ornusa Chalayon ◽  
Carla Chertman ◽  
Andrew D. Guss ◽  
Charles L. Saltzman ◽  
Florian Nickisch ◽  
...  
Keyword(s):  
Static Stability ◽  
Surgical Reconstruction ◽  
Plantar Plate ◽  
Metatarsophalangeal Joints

Irreducible Dislocation of All the Lesser Metatarsophalangeal Joints of the Foot

2012 ◽  
Vol 5 (5) ◽  
pp. 324-326 ◽  
Author(s):  
Devdatta Suhas Neogi ◽  
Shivanand M. Bandekar ◽  
Vilas Sadekar ◽  
Sarthak Patnaik ◽  
Trivikram Bhat ◽  
...  
Keyword(s):  
Open Reduction ◽  
Metatarsophalangeal Joint ◽  
Mechanism Of Injury ◽  
Therapeutic Level ◽  
Levels Of Evidence ◽  
Plantar Plate ◽  
Complex Anatomy ◽  
Metatarsophalangeal Joints

We report a case of irreducible dorsal dislocation of all the lesser metatarsophalangeal joints of the foot following injury at sport. Plantar plate prevented reduction at all the joints, which necessitated an open reduction and stabilization with K-wire. This report highlights the necessity of prompt open reduction and reviews the mechanism of injury and complex anatomy at metatarsophalangeal joint. Levels of Evidence: Therapeutic, Level IV, Case study

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