Obtaining A Rewarding Surgical Outcome With Plantar Plate Repair
- Doug Richie Jr. DPM FACFAS
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In a podiatric practice, a single rewarding interaction with a patient can easily override any of the negative encounters of the day. I recently had this type of positive experience with a patient who followed up six months after undergoing surgical repair of a tear of the plantar plate of the second metatarsophalangeal joint (MPJ).
The 57-year-old male patient initially presented with a severe deformity of his right second MPJ that had occurred rapidly over a four-month period. He was experiencing pain and swelling at the plantar aspect of the second MPJ with every step. The deformity of his toe was significantly affecting the fit and comfort in all forms of footwear. A clinical exam demonstrated positive drawer instability with loading of the second digit, indicating a loss of stability and integrity of the plantar plate of the second MPJ.
A course of conservative interventions, including taping, footwear modification and foot orthotic therapy, failed to improve symptoms. Therefore, I recommended surgical repair of the plantar plate. I have been using the new Complete Plantar Plate Repair System (CPR) developed by Arthrex.1 Michael Coughlin, DPM, and Lowell Weil Jr., DPM, developed this innovative technology and surgical technique.2,3 It provides a superior option for plantar plate repair in comparison to previous methods.
The CPR plantar plate repair allows the surgeon to perform a dorsal approach to the second MPJ with excellent visualization of the injured joint structures. One can accomplish the repair by using the new Mini Scorpion DX (Arthrex) to pass a FiberWire (Arthrex) suture through the plantar plate, and employing FastPass technology (Arthrex) to anatomically repair the base of the proximal phalanx. The strength of the repair facilitates a much shorter period of immobilization and more rapid return to activity for the athletic patient.
When I performed this procedure on this particular patient six months ago, he went through the usual period of postoperative stiffness and weakness of toe flexion at the second MPJ. He performed regular range of motion and strengthening exercises at home. I noted that almost all of the deficits had been resolved by the fourth month after the procedure and I released him to full sports activity.
I have performed more than 30 of these procedures during the past two years. I followed up with all of my patients for at least one year postoperatively to ensure that the results are satisfactory and durable.
That is why I recalled the patient coming to my office at six months after the procedure. The 57-year-old was fully functional by the fourth post-op month.
He told me he was very pleased with the results of surgery. To emphasize the positive effect this procedure had on his life, he shared a photo of himself surfing a perfect wave in Huntington Beach California. This photo was taken just a few weeks prior to his follow-up visit to my office.
Surfing is a demanding sport that people do barefoot on an extremely hard surface. The ability of the patient to return to this sport is a testimony to the positive functional outcome of his surgical repair of the plantar plate of the second MPJ. To see the result displayed on the backdrop of a beautiful day here in California adds icing on the cake.
This magnificent picture of a patient fully recovered from surgery enjoying his sport is among the most gratifying experiences I could have as a podiatric physician. It confirms that much of what we do restores mobility and greatly improves the quality of our patient’s lives.
1. Complete Plantar Plate Repair System (CPR™). Available at http://www.arthrex.com/foot-ankle/complete-plantar-plate-repair-system-cpr .
2. 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.
3. Weil L Jr., Sung W, Weil LS Sr., Malinoski K. Anatomic plantar plate repair using the Weil metatarsal osteotomy approach. Foot Ankle Spec. 2011; 4(3):145-150.