Pseudoneuroma sign of plantar plate tear

The incidence of medial sesamoid bone fracture is rare. Clinically they are often misdiagnosed as soft tissue injuries and often missed. Thus generates an important morbidity for the patient. Objectives: We present a case of turf-toe injury: plantar-plate rupture with medial sesamoid bone fracture in a contact athlete. Methods: A 19-year-old professional soccer player injured his left toe when he planted his foot during a sprint. He had an hyperextension and axial overload traumatism in his toe. On physical examination he had pain, swollen, ecchymosis, instability and loss of plantar-flexion strength. Radiographs showed a transverse medial sesamoid bone fracture with retraction > 3 mm. Magnetic resonance imaging confirmed a subluxation of the proximal phalange and a plantar plate disruption. Because of the completely deficient flexion, the sesamoid retraction, and the articular subluxation, surgery was recommended to restore the MTPJ anatomy. Reduction of the fracture and Repair of the plantar plate was performed using non-absorbable 2-0 Fiber wire sutures through a medial approach. Postoperatively, the patient was placed in a cast, for a total of 2 weeks. After that he began a rehabilitation program. Results: The patient had a complete recovery. He returned to participation in his team at 3 months. At final follow-up, his dorsiflexion ROM was 60 in the involved toe. Conclusion: Turf-toe and disorders of the sesamoid complex is an important injury, often misdiagnosed and usually undertreated. They had an incidence of 25% to 50% of residual pain and limited dorsiflexion in those cases. Despite the incidence of surgical treatment of 2%, we have found hopeful results with the open reduction and internal fixation of the fracture. Accurate and timely diagnosis and treatment can allow for full return to activity for these athletes.

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Correction of Severe Crossover Toe Deformity By Plantar Plate Tenodesis, Arthroscopic Release of Lumbrical and Plication of Lateral Capsuloligamentous Complex

Arthroscopy Techniques ◽

10.1016/j.eats.2021.04.011 ◽

2021 ◽

Author(s):

Tun Hing Lui ◽

Yi Lok Charis Chan

Keyword(s):

Arthroscopic Release ◽

Plantar Plate ◽

Toe Deformity

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Multiplanar Correction of the Lesser Digital Deviation and Indirect Plantar Plate Rupture Repair Using a Braided Polyethylene Nylon Suture: A Technique Guide

Foot & Ankle Specialist ◽

10.1177/1938640017724544 ◽

2017 ◽

Vol 10 (6) ◽

pp. 551-554 ◽

Cited By ~ 1

Author(s):

Cody D. Blazek ◽

Roberto A. Brandão ◽

Jeffrey M. Manway ◽

Patrick R. Burns

Keyword(s):

Sagittal Plane ◽

Digital Pathology ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Foot And Ankle ◽

Dorsal Approach ◽

Plantar Plate ◽

Direct Repair ◽

Nylon Suture ◽

A New Technique

Forefoot and lesser digital pathology continues to be a challenging area of surgical correction for foot and ankle surgeons. Many techniques for the correction of digital deformities secondary to plantar plate rupture, regardless of planal dominance, have been described including direct repair and metatarsal shortening osteotomies for repair. The authors present a new technique for multiplanar correction of deformed lesser digits without direct repair of the plantar plate rupture utilizing a specialty suture. The technique utilizes a braided synthetic polyethylene Nylon suture, which has been traditionally used for open or arthroscopic shoulder labrum repair, for the stabilization of the lesser metatarsophalangeal joint. This novel technique guide for the correction of transverse and sagittal plane deformities of the digit at the metatarsophalangeal joint negates the need for a plantar incisional approach for plantar plate repair or metatarsal head osteotomy from a dorsal approach with augmented stabilization. Levels of Evidence: Level V: Expert opinion

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DIAGNOSIS AND MANAGEMENT OF PLANTAR PLATE TEAR IN AN ELITE 400m HURDLER

Journal of Musculoskeletal Research ◽

10.1142/s0218957716720027 ◽

2016 ◽

Vol 19 (02) ◽

pp. 1672002

Author(s):

Robin Chatterjee ◽

Nikos Malliaropoulos ◽

Nat Padhiar

Keyword(s):

Surgical Management ◽

Repetitive Motion ◽

Diagnosis And Management ◽

Hammer Toe ◽

Plantar Plate ◽

Definitive Management ◽

Mtp Joints

The plantar plate is a fibrocartilaginous structure that lies deep to the metatarsal heads and provides stability to the metatarsophalangeal (MTP) joints. Repetitive motion may lead to irritation, inflammation and tear of the plate. In this case, a 400m hurdler reported metatarsalgia, swelling and misalignment of the second[Formula: see text]toe, in the absence of trauma. Pain was experienced during the toe off phase of hurdling. The patient had a hammer toe and a positive Lachman’s Test on examination. Fluoroscopy guided second MTP joint arthrogram confirmed the diagnosis of plantar plate tear. Complete Plantar Plate Repair and Weil’s Osteotomy were then carried out for definitive management after physiotherapy and analgesia failed to provide relief. Although there are numerous conservative measures to treat this ailment, surgical management remains the most effective.

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Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability

Foot and Ankle Surgery ◽

10.1016/j.fas.2007.01.001 ◽

2007 ◽

Vol 13 (3) ◽

pp. 116-121 ◽

Cited By ~ 47

Author(s):

Julie Gregg ◽

Morry Silberstein ◽

Callum Clark ◽

Tim Schneider

Keyword(s):

Joint Instability ◽

Metatarsophalangeal Joint ◽

Plantar Plate

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Microvasculature of the Plantar Plate Using Nano–Computed Tomography

Foot & Ankle International ◽

10.1177/1071100718816292 ◽

2018 ◽

Vol 40 (4) ◽

pp. 457-464 ◽

Cited By ~ 2

Author(s):

Fred T. Finney ◽

Aaron McPheters ◽

Natalie V. Singer ◽

Jaron C. Scott ◽

Karl J. Jepsen ◽

...

Keyword(s):

Computed Tomography ◽

Soft Tissues ◽

Proximal Phalanx ◽

Surgical Techniques ◽

Phosphomolybdic Acid ◽

Vascular Density ◽

Plantar Plate ◽

Tibial Arteries ◽

Clinical Conditions ◽

Mtp Joints

Background: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano–computed tomography (nano-CT) imaging. Methods: Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. Results: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate. Conclusion: There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate. Clinical relevance: The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.

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