Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability

Wesley W. Flint, David M. Macias, James R. Jastifer, Jesse Doty, Christopher B. Hirose, Michael J. Coughlin

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Lesser metatarsophalangeal (MTP) joint instability is a common cause of forefoot pain. Advances in operative technique and instrumentation have made it possible to anatomically treat plantar plate tears through a dorsal approach. Our goal was to evaluate the subjective, functional, and radiographic outcomes of plantar plate repair (PPR) from a dorsal approach. Methods: A prospective case series was performed evaluating the results of PPR in 97 feet with 138 plantar plate tears. Patients underwent PPR from a dorsal approach with a Weil osteotomy. We followed patients at regular intervals for 12 months and collected data preoperatively and postoperatively with respect to visual analog scale (VAS) scores, MTP range of motion (ROM), paper pull-out test, American Orthopaedic Foot & Ankle Society (AOFAS) scores, satisfaction, and radiographic measures. Results: Eighty percent of patients scored "good" to "excellent" satisfaction scores at 12 months. The mean VAS pain score preoperatively was 5.4/10, and postoperatively was 1.5/10. The mean AOFAS scores increased from 49 to 81 points following surgery. The mean MTP ROM preoperatively was 43 degrees and postoperatively 31 degrees. Forty-two percent of toes passed the paper pull out test prior to surgery and 54% at 12 months. Mean metatarsal shortening was 2.4/3.1/1.2 mm for the second, third, and fourth metatarsals, respectively. The mean MTP joint angles preoperatively were 2/4.9/-1.3 degrees and postoperatively were 7.4/9.6/0.2 degrees, respectively, for the second, third, and fourth MTP joints. Conclusion: We found that the plantar plate could be repaired through a dorsal approach with reliable outcomes. PPR was a viable option to anatomically restore the ligamentous support in the unstable lesser MTP joint. Level of Evidence: Level IV, retrospective case series.

Original languageEnglish (US)
Pages (from-to)234-242
Number of pages9
JournalFoot and Ankle International
Volume38
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Metatarsophalangeal Joint
Joint Instability
Metatarsal Bones
Articular Range of Motion
Toes
Pain Measurement
Osteotomy
Plantar Plate
Visual Analog Scale
Ankle
Orthopedics
Foot
Pain

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Flint, W. W., Macias, D. M., Jastifer, J. R., Doty, J., Hirose, C. B., & Coughlin, M. J. (2017). Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability. Foot and Ankle International, 38(3), 234-242. https://doi.org/10.1177/1071100716679110

Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability. / Flint, Wesley W.; Macias, David M.; Jastifer, James R.; Doty, Jesse; Hirose, Christopher B.; Coughlin, Michael J.

In: Foot and Ankle International, Vol. 38, No. 3, 01.03.2017, p. 234-242.

Research output: Contribution to journalArticle

Flint, WW, Macias, DM, Jastifer, JR, Doty, J, Hirose, CB & Coughlin, MJ 2017, 'Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability', Foot and Ankle International, vol. 38, no. 3, pp. 234-242. https://doi.org/10.1177/1071100716679110
Flint, Wesley W. ; Macias, David M. ; Jastifer, James R. ; Doty, Jesse ; Hirose, Christopher B. ; Coughlin, Michael J. / Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability. In: Foot and Ankle International. 2017 ; Vol. 38, No. 3. pp. 234-242.
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