Correcting The Crossover Toe With Direct Plantar Plate Repair

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Six Key Surgical Tips To Remember

1) One should perform a small dorsal incision for release of the MPJ contracture and a metatarsal osteotomy (if necessary) first.
2) Complete a partial tear in a transverse fashion and resect 2 to 3 mm of redundant plantar plate once you have pinned the toe and MPJ with a wire.
3) Utilize a pants-over-vest primary repair with a non-absorbable suture and a UR-6 needle to allow for easier suture passing.
4) If one encounters a complete tear from the proximal phalanx, consider a small suture anchor in the proximal phalanx for added fixation.
5) Maintain the use of a wire in a plantarflexed position for at least four weeks postoperatively during healing.
6) Careful anatomic dissection and retraction, as well as eversion of skin edges during closure, will help prevent a painful plantar scar.

Kyle S. Peterson, DPM, AACFAS, and Christopher F. Hyer, DPM, MS, FACFAS

1. 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.
2. Coughlin MJ. Subluxation and dislocation of the second metatarsophalangeal joint. Orthop Clin North Am. 1989; 20(4):535-551.
3. 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.
4. Thompson FM, Hamilton WG. Problems of the second metatarsophalangeal joint. Orthopedics. 1987; 10(1):83-89.
5. Klein EE, Weil L Jr, Weil LS Sr, Knight J. Magnetic resonance imaging versus musculoskeletal ultrasound for identification and localization of plantar plate tears. Foot Ankle Spec. 2012; 5(6):359-365.
6. Klein EE, Weil L Jr, Weil LS Sr, Knight J. Musculoskeletal ultrasound for preoperative imaging of the plantar plate: a prospective analysis. Foot Ankle Spec. 2013; 6(3):196-200.
7. Gregg J, Silberstein M, Clark C, Schneider T. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot Ankle Surg. 2007; 13(3):116-121.
8. 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.
9. Coughlin MJ, Schutt SA, Hirose CB, et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int. 2012; 33(2):133-40.

   For further reading, see “Emerging Concepts In Treating Second Crossover Toe Deformity” in the October 2009 issue of Podiatry Today.

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