Plantar plate anatomy

NewsBot · Aug 20, 2016

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Metatarsophalangeal joint stability: a systematic review on the plantar plate of the lesser toes
Nico M. G. Maas, Margot van der Grinten, Wichor M. Bramer and Gert-Jan Kleinrensink
Journal of Foot and Ankle Research20169:32

Background
Instability of the metatarsophalangeal (MTP) joints of the lesser toes (digiti 2?5) is increasingly being treated by repair of the plantar plate (PP). This systematic review examines the anatomy of the plantar plate of the lesser toes, and the relation between the integrity of the plantar plates of the lesser toes and lesser MTP joint stability.

Methods
The databases of Embase.com, Medline (Ovid), Web of Science, Scopus, Cochrane, Pubmed not medline, Cinahl (ebsco), ProQuest, Lilacs, Scielo and Google Scholar were searched in June 2015 from inception. Studies were included if they were in English, contained primary data, and had a focus on plantar plate anatomy of the lesser toes or on the relationship between integrity of the plantar plate and MTP joint (in)stability. Study characteristics were extracted into two main tables and descriptive anatomical and histological data were summarized into one schematic 3D drawing of the plantar plate.

Results
Nine studies were included in this systematic review, of which five addressed plantar plate anatomy as such and four focused directly and indirectly on plantar plate integrity related to MTP joint stability.

Conclusion
This is the first systematic review regarding plantar plate anatomy related to MTP joint stability of the lesser toes. This review iterates the importance of plantar plate anatomy and integrity for MTP joint stability, and it delineates the lack of primary data regarding plantar plate anatomy of the lesser toes and MTP joint stability.
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Admin2 · Aug 20, 2016

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NewsBot · Nov 7, 2016

THE EFFECT OF THE PLANTAR PLATE ON PLANTAR APONEUROSIS STRAIN: 3D FlNlTE ELEMENT MODELING OF FOOT AND ANKLE
Zeeshan Qaiser, Ou Hai Hua, Shane Johnson
International Conference of Biomechanics in Sport (2016)

Experimental measurements of stresses and strains for the Lower Extremity Injuries (LEI) are invasive, and therefore, predictions require physiologically accurate 3D Finite Element (FE) models of the foot and ankle. Previous FE models of foot and ankle in the literature neglect the function of the plantar plate, and therefore, these models underestimate the Plantar Aponeurosis (PA) strain. In this study the effect and function of the plantar plate on PA strain and other biomechanical parameters of foot and ankle are studied. The Soft Tissue (ST) and PA are analysed as hyperelastic materials supplemented by material sensitivity analysis. The plantar plate Is contributlng towards more accurate prediction of PA strain (1-1.4% at full body weight during balanced standing). Material properties of ST also highly affect the PA strain, and it is a primary feature in validating FE models.
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NewsBot · Sep 24, 2017

Angiology of the Plantar Plate
A Novel Technique for Imaging of the Plantar Plate Microvasculature
Fred Finney, MD, Basma Khoury, MS, Jaron Scott, MS, ...
Foot & Ankle Orthopaedics September 18, 2017

Introduction/Purpose:
Hammertoes, crossover toes, and claw toes are common deformities and can be a major source of pain and dysfunction. These deformities result from instability of the metatarsophalangeal (MTP) joint due to incompetence of the plantar plate and/or collateral ligaments. Non-operative management is the first line of treatment. When non-operative treatment is unsuccessful, surgical interventions have been described. Newer surgical techniques focus on performing anatomic repairs of plantar plates. The vasculature of the foot has been well studied, but the vascular supply of the plantar plate has not been described. This study presents a new technique for imaging the microvasculature of the lesser toe plantar plates through micro- computed tomography (micro-CT) in order to better understand tear pathology and the capacity of healing with plantar plate repairs.

Methods:
The posterior tibial and dorsalis pedis arteries of a fresh frozen human cadaver foot were dissected and cannulated at the ankle for perfusion distally. After administration of an anticoagulant, each artery was perfused with Microfil® Silicone Rubber, a contrast agent. The compound was then allowed to cure, and the foot was fixed in formalin. The foot was sectioned through the metatarsal shafts for imaging, and imaging of the lesser toe MTP joints was performed using a Bruker Skyscan 1176 micro-CT scanner at 18 micron slices. Computerized reconstruction of the images was performed for three dimensional visualization of the vasculature.

Results:
Post-perfusion imaging of the lesser toe MTP joints using micro-CT allows for visualization of the plantar plate microvasculature. Preliminary imaging suggests that micro-CT is a useful modality for analysis of the blood supply of the plantar plate.

Conclusion:
Anatomic repair of the plantar plate has become a viable treatment option for MTP joint instability. One important question that remains to be answered is whether plantar plate tears have the capacity to heal. We present a novel technique for imaging of lesser toe plantar plate microvascularity using micro-CT. Preliminary results of post-perfusion imaging of the plantar plate are promising for developing a better understanding of its blood supply. Further definition of the plantar plate vascular supply will help clinicians understand the capacity for healing after repairs and may provide some insight to the biological causes plantar plate tears.
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NewsBot · Apr 26, 2018

Microvasculature of the Plantar Plate Using Nano-Computed Tomography
Fred Finney, MD, Jaron Scott, MS, James Holmes, MD, ...
Foot & Ankle Orthopaedics April 19, 2018

Introduction/Purpose:
Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of very common clinical complaints including metatarsalgia, metatarsal-phalangeal (MTP) joint subluxation and dislocation, hammertoe, crossover toe, etc. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been addressed. We sought to answer this question by employing a novel technique involving microvascular perfusion and nano-computed tomography (Nano-CT) imaging.

Methods:
12 human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were dissected and cannulated proximal to the ankle joint and were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The 2nd through 4th toe MTP joints of 12 feet were imaged with Nano-CT at 14-micron resolution. Images were then reconstructed for three-dimensional analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate.

Results:
A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The mid-substance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 30% and distal 20% of the plantar plate (Figure 1).

Conclusion:
There is a vascular network extending from the surrounding soft tissues into approximately the proximal 30% and the distal 20% of the plantar plate. The hypovascular mid-portion of the plantar plate may play an important role in the underlying patho-anatomy and pathophysiology of this area. We believe our findings likely have significant clinical implications for the reparative potential of this region, and therefore the surgical procedures currently described to accomplish anatomic plantar plate repair.
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NewsBot · Dec 20, 2018

Microvasculature of the Plantar Plate Using Nano–Computed Tomography
Fred T. Finney, MD, Aaron McPheters, Natalie V. Singer, MD, ...
Foot & Ankle International December 19, 2018

Background:
Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano–computed tomography (nano-CT) imaging.

Methods:
Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate.

Results:
A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate.

Conclusion:
There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate.

Clinical relevance:
The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.
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NewsBot · Jul 8, 2019

HISTOLOGICAL CHANGES OF THE PLANTAR PLATE IN PATIENTS WITH METATARSALGIA
Olena Turchin, Anastasiya Grigorovskaya, Andriy Lyabakh, Oleksandr Kostrub
No 2 (2019) > Turchin

The plantar plate of the lesser toes is wide, strong and flexible fibro-cartilaginous structure of a rectangular or trapezoidal shape, passing from the plantar surface of the metatarsal neck to the base of the proximal phalanx. It is believed that degenerative changes of the plantar plate that occur during longterm cyclic overloads are the main cause of pain and the development of metatarsalgia.

Objective: analysis of the plantar plate histology results in patients with metatarsalgia.

Methods: 16 lesser metatarsophalangeal joint plantar plates of the 9 patients (2 were males, 7 were females with average age of (65.28 ± 10.32) years) with metatarsalgia were obtained for histology assessment (the second metatarsophalangeal joint plantar plates were 12, the third — 4). 8 plantar plate after lesser toe exarticulation, 8 — after resection arthroplasty were obtained. Fragments of plantar plate with proximal phalanx were selected for histology. Paraffin sections were analyzed with bright-field light microscopy (Olympus CX-41). Grades of severity of morphology were evaluated by VAS.

Results: the material in plantar plate biopsies was represented by fragments of pathologically altered connective tissue, changes in the regularity and density of collagen fibers, the appearance of blood vessels, a combination of loose connective tissue and dense connective tissue; subtotal and total fibronecrosis with complete degeneration of the fibrous-cartilage structure of the enthesis.

Conclusions: histological changes of the plantar plate in patients with metatarsalgia are characterized by an irreversible dystrophicdegenerative process in the fibrous-cartilage structure of the enthesis, which morphologically corresponds to non-specific enthesopathy.
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NewsBot · Feb 14, 2021

Presence of Neovascularization in Torn Plantar Plates of the Lesser Metatarsophalangeal Joints
Natalie V. Singer, MD, Noah E. Saunders, BBA, James R. Holmes, MD, ...
Foot & Ankle International February 9, 2021

Background:
Recent surgical techniques have focused on anatomic repair of lesser toe metatarsophalangeal (MTP) plantar plate tears, yet it remains unknown whether the plantar plate has the biological capacity to heal these repairs. Therefore, a better understanding of the plantar plate vasculature in response to injury may provide further insight into the potential for healing after anatomic plantar plate repair. Recently, a study demonstrated that the microvasculature of the normal plantar plate is densest at the proximal and distal attachments. The purpose of this study was to compare the intact plantar plate microvasculature network to the microvasculature network of plantar plates in the presence of toe deformity using similar perfusion and nano–computed tomographic (CT) imaging methods.

Methods:
Seven fresh-frozen human cadaveric lower extremities with lesser toe deformities including hammertoe or crossover toe were perfused using a barium solution. The soft tissues of each foot were counterstained with phosphomolybdic acid (PMA). Then using nano-CT imaging, the second through fourth toe metatarsophalangeal joints of 7 feet were imaged. These images were then reconstructed, plantar plate tears were identified, and 11 toes remained. The plantar plate microvasculature for these 11 toes was analyzed, and calculation of vascular density along the plantar plate was performed. Using analysis of variance (ANOVA), this experimental group was compared to a control group of 35 toes from cadaveric feet without deformity and the vascular density compared between quartiles of plantar plate length proximal to distal. A power analysis was performed, determining that 11 experimental toes and 35 control toes would be adequate to provide 80% power with an alpha of 0.05.

Results:
Significantly greater vascular density (vascular volume/tissue volume) was found along the entire length of the plantar plate for the torn plantar plates compared to intact plantar plates (ANOVA, P < .001). For the first quartile of length (proximal to distal), the vascular density for the torn plantar plates was 0.365 (SD 0.058) compared to 0.281 (SD 0.036) for intact plantar plates; in the second quartile it was 0.300 (SD 0.044) vs 0.175 (SD 0.025); third quartile it was 0.326 (SD 0.051) vs 0.117 (SD 0.015); and fourth (most distal) quartile was 0.600 (SD 0.183) vs 0.319 (SD 0.082).

Conclusion:
Torn plantar plates showed increased vascular density throughout the length of the plantar plate with an increase in density most notable in the region at or just proximal to the attachment to the proximal phalanx. Our analysis revealed that torn plantar plates exhibit neovascularization around the site of a plantar plate tear that does not exist in normal plantar plates.
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NewsBot · Nov 22, 2022

Vascular Supply to the Proximal Plantar Plate of Lesser Toe Metatarsophalangeal Joint is Primarily Supplied by the Attachment to the Metatarsal: A Nano-CT Microvasculature Study
Jiwon V. Park, Fred T. Finney, MD, […], and Paul G. Talusan, MD
Source

Introduction/Purpose:
Lesser toe metatarsophalangeal (MTP) instability is implicated in common forefoot pain and deformities. The plantar plate is a major stabilizing structure of the MTP joint with instability frequently occurring after a tear or attenuation of this structure. Previous studies have demonstrated that the blood supply to the proximal plantar plate comes from both the metatarsal and the plantar fascia. Commonly, a McGlamry elevator is used to strip the plantar plate from the plantar surface of the metatarsal to improve exposure of the MTP joint. The vascular consequence of stripping the plantar plate from the metatarsal is not yet well understood. The purpose of this study is to quantify the relative contribution of blood supply to the proximal plantar plate from the metatarsal and plantar fascia.
Methods:
Twelve fresh-frozen human adult cadaver lower extremity specimens were utilized for this study, resulting in 35 lesser MTP joints that were studied. All specimens were between the ages of 18 and 65 years and had no history of diabetes, peripheral vascular disease, or connective tissue disorders. Specimens with a history of trauma to the foot or ankle, prior foot or ankle surgery, or evidence of clinical deformity of less toes upon inspection were excluded. The specimens were prepared as described previously in Finney et al. The anterior and posterior tibial arteries were perfused with a barium solution and counterstained with phosphomolybdic acid. The second through fourth MTP joints of 12 feet were imaged with nano-computed tomography (nano- CT) at 14-micron resolution. Reconstructed 3D and 2D CT images were utilized for analysis of the volume of vasculature along the metatarsal pedicle and plantar fascia of the proximal plantar plate.
Results:
Based on nano-CT imaging, the plantar plate specimen demonstrated microvascular infiltration at the proximal attachments of the metatarsal neck, interosseous muscles, periosteum, and plantar fascia (Figure 1). An average of 63.5% of the vascular supply to the proximal portion of the plantar plate entered from the metatarsal pedicle in 35 lesser toe specimens analyzed. The remaining 36.5% of the vascular supply entered from the plantar fascia. The second toes, third toes, and fourth toes had an average of 64.7%, 59.0%, and 67.1% of vasculature supply from the metatarsal pedicle, respectively. The average volume of vasculature from the metatarsal pedicle to the proximal plantar plate was 0.38 mm3, while the average volume of vasculature from the plantar fascia to the proximal plantar plate was 0.19 mm3.
Conclusion:
The vascular supply of the proximal plantar plate is supplied from both the metatarsal pedicle and plantar fascia. Using the McGlamry elevator for exposure of the MTP joint disrupts the dominant tributary for proximal plantar plate perfusion.
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Plantar plate anatomy

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Plantar plate anatomy

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Plantar Plate Anatomy re Plantar plate tear

Plantar Plate Strains

Surgery for Plantar Plate Tears

The FixToe Device for Plantar Plate issues

How long did it take your plantar plate injury to heal?

Platelet-rich plasma for plantar warts

Plantar plate tears in Morton's Neuroma

Share This Page

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