I am happy to report that my patients and I have been pleased with the results of the suture and button stabilization technique used for stabilizing plantar plate insufficiency associated with lesser metatarsophalangeal joint (MPJ) instability. (See the February 2011 Podiatry Today cover story at http://www.podiatrytoday.com/current-insights-treating-second-mpj-dysfun...  and a previous blog I did on this subject at http://www.podiatrytoday.com/blogged/questions-and-answers-suture-and-bu...  .)
I have been using this technique for more than a year now. I have used it successfully in cases of isolated second MTPJ dysfunction and in cases of failed arthroplasty of the proximal interphalangeal joint (PIPJ) associated with MTPJ instability and pain in the sub-second metatarsal. I have even used it in isolated digital instability associated with painful sub lesser MTPJ lesions in isolation. The suture and button technique has proven useful in conjunction with hallux abducto valgus correction and I have been pleased with patients’ tolerance of the procedure.
Patients have been pleased since I can perform most suture and button stabilizations without the need for PIPJ arthrodesis. The procedure also provides digital realignment free of external pinning. Over this past year, people have presented with end stage PIPJ and MTPJ derangement as a complication of previous surgery. This technique has provided a means to achieve pain relief and return these patients to forefoot weightbearing without disability or impairment.
I emphasize to patients that they will require the use of a metatarsal sling pad as a long-term means of protecting their successful outcome, much the same as people use a nighttime brace after having braces removed from their teeth. Obviously, I do not encourage barefoot weightbearing in this patient subset. The majority of these patients are so grateful for the ability to return to walking and driving activities that they are willing to tolerate this long-term plan for preventing recurrence.
I am happy to bring you a detailed account of these cases with illustrations and patient evaluation surveys conducted pre-op, six weeks post-op, four months post-op and then again in the long term. In this short-term follow up (greater than one year), there have been no failures at achieving pain relief and significant improvement in MTPJ alignment.
Look for the manuscript in one of your favorite peer-reviewed journals in the near future. I hope to post a gait evaluation video soon. In the interim, thank you for your support and continued interest.