Current Concepts In Plantar Plate Repair

Start Page: 62
72
Author(s): 
Lowell Weil Jr., DPM, FACFAS, and Erin E. Klein, DPM, MS

References
1. Highlander P, VonHerbulis E, Gonzalez A, Britt J, Buchman J. Complications of the Weil Osteotomy. Foot Ankle Spec. 2011;4(3):165-70.
2. Garg R, Thordarson DB, Schrumpf M, Castaneda D. Sliding oblique versus segmental resection osteotomies for lesser metatarsophalangeal joint pathology. Foot Ankle Int. 2008; 29(10):1009-14.
3. Migues A, Slullitel G, Bilbao F, Carrasco M, Solari G. Floating-toe deformity as a complication of the Weil osteotomy. Foot Ankle Int 2004; 25(9):609-13.
4. Joseph R, Schroeder K, Greenberg M. A retrospective analysis of lesser metatarsophalangeal joint fusion as a treatment option for hammertoe patholiogy associated with metatarsophalangeal joint instability. J Foot Ankle Surg. 2012; 51: 57–62.
5. Baravarian B, Thompson J, Nazarian D. Plantar plate tears: a review of the modified flexor tendon transfer repair of stabilization. Clin Pod Med Surg. 2011; 28: 57–58.
6. Bouche 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.
7. Klammer G, Baumann G, Kaspar Moor B, Farshad M, Espinosa N. Early complication and recurrence rates after kirschner wire transfixation in lesser toe surgery: a prospective randomized study. Foot Ankle Int. 2012; 33(2):105-112.
8. Coughlin MJ. Second metatarsophalangeal joint instability in the athlete. Foot Ankle. 1993; 14:309-319.
9. Cruveilhier J. The Anatomy of the Human Body. Harper & Bros, New York, 1844, pp. 176.
10. Stainsby GD. Pathological anatomy and dynamic offect of the displaced paltnar plate and the importance of the integrity of the plantar plate-deep transverse intermetatarsal ligament tie-bar. Ann R Coll Surg Engl. 1997; 79:58-68.
11. Bhatia D, Myerson MS, Curtis MJ, Cunningham BW, Jinnah RH. Anatomical restraints to dislocation of the second metatarsophalangeal joint and assessment for repair technique. JBJS. 1994; 76A(9):1371-1375.
12. Coughlin M, Schutt SA, Hirose CB, et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int. 2012; 33(2):133-140.
13. 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):1079-81.
14. Gregg J, Silberstein M, Schneider T, Marks P. Sonographic and MRI evaluation of the plantar plate: A prospective study. Eur Radiol. 2006; 16(12):2661-9.
15. Sung W, Burns P, Wukich D. Radiographic outcomes of primary first metatarsophalangeal joint arthrodesis for hallux abductovalgus deformities. E-Poster Competition, 26th Annual Summer Meeting of the American Orthopaedic Foot & Ankle Society, July 7-10, 2010
16. 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):132-41.
17. 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):145-50.

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  Michele Kurlanskisays:
  April 5, 2012 at 12:20 pm
  
In your experience, do you think patients have plantar plate tears because of a long second metatarsal and a functional hallux limitus, or an elevated first ray? If so, do you treat the 1st MTPJ pathology surgically at the same time or just address the 2nd MTPJ? 

  

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  Dr. Victor J Runcosays:
  January 20, 2013 at 8:39 am
  
Some patients I see who have ALL the signs and symptoms of a grade 1-2 plantar plate tear sometimes have negative MRI findings. When they do not respond to conservative treatment, I often have difficulty getting a surgeon to operate on them.


This is different in knees for some reason. Often, the knee surgeon will do exploratory surgery and find the issue and fix it in spite of a lack of MRI findings.


My question is: Do you operate with a lack of MRI findings and if so, do you often find the cause during the operation?

  

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