Etiology, Clinical Assessment, and Surgical Repair of Plantar Plate Tears

Abstract

The plantar plate has recently gained more attention as an important structure contributing to lesser metatarsophalangeal joint stability. This has prompted a significant growth of interest in the anatomy and biomechanics of the plantar plate and in the diagnosis and treatment of its injuries. Improved understanding of plantar plate function and predictable patterns of degeneration and failure has led to the development of a clinical staging and surgical grading system of plantar plate lesions. Relatively recent innovations allow the surgeon to access and repair plantar plate tears directly with reinsertion onto the base of the proximal phalanx. The addition of direct plantar plate repair represents a significant advance in the surgical restoration of alignment and functional stability of the lesser metatarsophalangeal joint.

Keywords

plantar plate - plantar plate tears - lesser toes deformities - metatarsophalangeal joint instability - plantar plate anatomy - treatment

• References

• 1 Cooper MT, Coughlin MJ. Sequential dissection for exposure of the second metatarsophalangeal joint. Foot Ankle Int 2011; 32 (3) 294-299
• 2 Deland JT, Lee KT, Sobel M, DiCarlo EF. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int 1995; 16 (8) 480-486
• 3 Suero EM, Meyers KN, Bohne WH. Stability of the metatarsophalangeal joint of the lesser toes: a cadaveric study. J Orthop Res 2012; 30 (12) 1995-1998
• 4 Nery C, Coughlin MJ, Baumfeld D, Mann TS. Lesser metatarsophalangeal joint instability: prospective evaluation and repair of plantar plate and capsular insufficiency. Foot Ankle Int 2012; 33 (4) 301-311
• 5 Kier R, Abrahamian H, Caminear D , et al. MR arthrography of the second and third metatarsophalangeal joints for the detection of tears of the plantar plate and joint capsule. AJR Am J Roentgenol 2010; 194 (4) 1079-1081
• 6 Umans H, Srinivasan R, Elsinger E, Wilde GE. MRI of lesser metatarsophalangeal joint plantar plate tears and associated adjacent interspace lesions. Skeletal Radiol 2014; 43 (10) 1361-1368
• 7 Lepage-Saucier M, Linda DD, Chang EY , et al. MRI of the metatarsophalangeal joints: improved assessment with toe traction and MR arthrography. AJR Am J Roentgenol 2013; 200 (4) 868-871
• 8 Nery C, Coughlin MJ, Baumfeld D, Mann TS, Yamada AF, Fernandes EA. MRI evaluation of the MTP plantar plates compared with arthroscopic findings: a prospective study. Foot Ankle Int 2013; 34 (3) 315-322
• 9 Doty JF, Coughlin MJ. Metatarsophalangeal joint instability of the lesser toes and plantar plate deficiency. J Am Acad Orthop Surg 2014; 22 (4) 235-245
• 10 Sarrafian SK, Topouzian LK. Anatomy and physiology of the extensor apparatus of the toes. J Bone Joint Surg Am 1969; 51 (4) 669-679
• 11 Deland JT, Sung IH. The medial crossover toe: a cadaveric dissection. Foot Ankle Int 2000; 21 (5) 375-378
• 12 Coughlin MJ, Baumfeld DS, Nery C. Second MTP joint instability: grading of the deformity and description of surgical repair of capsular insufficiency. Phys Sportsmed 2011; 39 (3) 132-141
• 13 Mendicino RW, Statler TK, Saltrick KR, Catanzariti AR. Predislocation syndrome: a review and retrospective analysis of eight patients. J Foot Ankle Surg 2001; 40 (4) 214-224
• 14 Yu GV, Judge MS, Hudson JR, Seidelmann FE. Predislocation syndrome. Progressive subluxation/dislocation of the lesser metatarsophalangeal joint. J Am Podiatr Med Assoc 2002; 92 (4) 182-199
• 15 Umans R, Umans B, Umans H, Elsinger E. Predictive MRI correlates of lesser metatarsophalangeal joint (MPJ) plantar plate (PP) tear. Skeletal Radiology 2016; DOI 10.1007/s00256-016-2375-x
• 16 Doty JF, Coughlin MJ. Metatarsophalangeal joint instability of the lesser toes. J Foot Ankle Surg 2014; 53 (4) 440-445
• 17 Smith BW, Coughlin MJ. Disorders of the lesser toes. Sports Med Arthrosc Rev 2009; 17 (3) 167-174
• 18 Nery C, Coughlin MJ, Baumfeld D, Raduan FC, Mann TS, Catena F. Classification of metatarsophalangeal joint plantar plate injuries: history and physical examination variables. J Surg Orthop Adv 2014; 23 (4) 214-223
• 19 Nery C, Coughlin MJ, Baumfeld D, Raduan FC, Mann TS, Catena F. Prospective evaluation of protocol for surgical treatment of lesser MTP joint plantar plate tears. Foot Ankle Int 2014; 35 (9) 876-885
• 20 Kaz AJ, Coughlin MJ. Crossover second toe: demographics, etiology, and radiographic assessment. Foot Ankle Int 2007; 28 (12) 1223-1237
• 21 Thompson FM, Hamilton WG. Problems of the second metatarsophalangeal joint. Orthopedics 1987; 10 (1) 83-89
• 22 Bouché RT, Heit EJ. Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal joints: preliminary observations. J Foot Ankle Surg 2008; 47 (2) 125-137
• 23 Powless SH, Elze ME. Metatarsophalangeal joint capsule tears: an analysis by arthrography, a new classification system and surgical management. J Foot Ankle Surg 2001; 40 (6) 374-389
• 24 Haddad SL, Sabbagh RC, Resch S, Myerson B, Myerson MS. Results of flexor-to-extensor and extensor brevis tendon transfer for correction of the crossover second toe deformity. Foot Ankle Int 1999; 20 (12) 781-788
• 25 Nery C, Raduan FC, Catena F, Mann TS, de Andrade MA, Baumfeld D. Plantar plate radiofrequency and Weil osteotomy for subtle metatarsophalangeal joint instability. J Orthop Surg 2015; 10: 180
• 26 Nery C, Coughlin MJ, Baumfeld D , et al. Lesser metatarsal phalangeal joint arthroscopy: anatomic description and comparative dissection. Arthroscopy 2014; 30 (8) 971-979
• 27 Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int 2008; 29 (8) 871-879
• 28 Trepman E, Yeo SJ. Nonoperative treatment of metatarsophalangeal joint synovitis. Foot Ankle Int 1995; 16 (12) 771-777
• 29 Ford LA, Collins KB, Christensen JC. Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate. J Foot Ankle Surg 1998; 37 (3) 217-222
• 30 Weil Jr L, Sung W, Weil Sr LS, Malinoski K. Anatomic plantar plate repair using the Weil metatarsal osteotomy approach. Foot Ankle Spec 2011; 4 (3) 145-150