Metatarsophalangeal Joint Pathology in Crossover 2nd Toe Deformity: A Cadaveric Study

Kevin Kirby · Feb 12, 2012

Members do not see these Ads. Sign Up.
I just read an excellent cadaver study on correlating crossover 2nd toe deformity to plantar plate and MPJ collateral ligament tears that I believe all podiatrists should be aware of.

Metatarsophalangeal Joint Pathology in Crossover Second Toe Deformity: A Cadaveric Study - Michael J. Coughlin, MD; Shane A. Schutt, MD; Christopher B. Hirose, et al

Foot & Ankle International, February 2012 (Vol.33 #2) pages 133-140

Summary: Ligamentous and capsular insufficiency of the second metatarsophalangeal joint has been surgically treated for over two decades, mainly with indirect surgical repairs, which stabilize adjacent soft tissue and shorten or decompress the osseous structures. While ligamentous insufficiency has been described and recognized, degeneration of the plantar plate and tears of the capsule have rarely been documented. The purpose of this study was to document and describe the presence and pattern of plantar plate tears in specimens with crossover second toe deformities, and based on this, to develop an anatomical grading system to assist in the assessment and treatment of this condition.

Methods: Sixteen below-knee cadaveric specimens with a clinical diagnosis of a second crossover toe deformity were examined, and dissected by removing the metatarsal head. The pathologic findings of plantar plate and capsular pathology, as well as ligamentous disruption, were observed and recorded. Demographics of the specimens were recorded, and simulated weightbearing radiographs were obtained prior to dissection so that pertinent angular measurements could be obtained.

Results: Demographics demonstrated a high percentage of female specimens, and a typically older population that has been reported for this condition. Radiographic findings documented a high percentage of hallux valgus and hallux rigidus deformities. The MTP-2 and MTP-3 angles were divergent consistent with a crossover toe deformity. We consistently found transverse tears in the plantar plate region immediately proximal to the capsular insertion on the base of the proximal phalanx. With increasing deformity, wider distal transverse tears extending from lateral to medial were found. Midsubstance tears, collateral ligament tears, and complete disruption of the plantar plate were found in more severe deformities.

Conclusion: In this largest series of cadaveric dissections of crossover second toe deformities, we describe the types and extent of plantar plate tears associated with increasing deformity of the second ray. We present, based on these findings, an anatomic grading system to describe the progressive anatomic changes in the plantar plate.
Click to expand...

Admin2 · Feb 12, 2012

Related threads:
Other threads tagged with plantar plate

drsarbes · Feb 20, 2012

Thanks Kevin.
Which do you think came first, the dorsal subluxation causing the tear, or the tear causing instability and dorsal subluxation?

I'm not sure how you repair these, but I always perform a shortening osteotomy on the 2nd. I rarely actually look for a plantar plate tear, I just assume it's there. No repair on the plantar plate necessary.

Steve

NewsBot · Mar 20, 2012

Correction of crossover deformity of second toe by combined plantar plate tenodesis and extensor digitorum brevis transfer: a minimally invasive approach.
Lui TH.
Arch Orthop Trauma Surg. 2011 Sep;131(9):1247-52

PURPOSE:
To study the efficacy and safety of the combined plantar plate tenodesis and extensor digitorum brevis transfer in correction of claw toe deformity.

METHODS:
Between 2007 and 2008, 11 patients (13 feet) underwent combined plantar plate tenodesis and EDB transfer for the correction of crossover second toe deformity. The clinical and radiological results were studied.

RESULTS:
There was no more crossover toe deformity in all patients. Two patients had residual mild residual claw toe deformity. The lateral metatarsophalangeal angle in preoperative weight-bearing radiograph averaged 53° ± 5°. The postoperative lateral metatarsophalangeal angle averaged 23° ± 6°. The dorsoplantar metatarsophalangeal angle in preoperative weight-bearing radiograph averaged -9° ± 4°. The postoperative dorsoplantar metatarsophalangeal angle averaged 2° ± 4°.

CONCLUSIONS:
Combined plantar plate tenodesis and extensor digitorum brevis transfer is an effective procedure to correct crossover second toe deformity. This is a relatively simple procedure and can be preformed through small incisions with minimal soft tissue dissection.
Click to expand...

NewsBot · Oct 31, 2021

Correction of Crossover Toe Deformity by Plantar Plate Tenodesis and Arthroscopic Release of Lumbrical
Tun HingLui et al
Arthroscopy TechniquesVolume 10, Issue 6, June 2021, Pages e1621-e1626

Plantar plate deficiency is the major cause of instability of the metatarsophalangeal joint. As the joint subluxates dorsally, the lumbrical is tethered on the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover toe deformity. Release of the lumbrical is needed to achieve adequate medial soft-tissue release. Plantar plate tenodesis has been described to correct the deformity by suturing the plantar plate to the extensor digitorum longus tendon. The purpose of this Technical Note is to incorporate the technique of arthroscopic release of the lumbrical tendon into the technique of plantar plate tenodesis.
Click to expand...

NewsBot · Jun 2, 2022

Valgus Second Toe Deformity Treated With a Percutaneous Extracapsular Closing-Wedge Osteotomy of the Proximal Phalanx [Formula: see text]
Robbie Ray et al
Foot Ankle Int. 2022 Jun 2

Background: Coronal and sagittal plane deformities of the lesser toes are common yet challenging to treat. Traditional open releases and translational Weil osteotomies can be unpredictable and lead to postoperative stiffness. We present the results of a percutaneous closing wedge extracapsular osteotomy of the proximal phalanx to treat valgus deformity of the second toe.

Methods: Thirty-one patients underwent 40 percutaneous osteotomies at a median age of 58.6±9.4 years. Using a small dorsomedial incision, a percutaneous proximal metaphyseal medial closing-wedge extracapsular osteotomy of the second toe is performed, leaving the dorsolateral cortex intact. An irrigated low-speed, high-torque 2- × 8-mm burr is used under image guidance. The osteotomy is then closed to correct deformity and taped for 2 weeks. Patient-reported outcomes and weightbearing radiographs were obtained.

Results: Questionnaire data was available for 89.7% (n=35) of cases. Most cases (91.4%) were either satisfied or extremely satisfied with the procedure. Radiographs were available for 90.0% of osteotomies, with a median length from surgery to radiographic follow-up of 1.6 years (range 0.5-6.3; SD ±1.5). Median second-toe valgus angle (STVA) decreased from 16.2±10.7 degrees to 5.0±7.0 degrees (P < .001) at final follow-up. All osteotomies united with no delayed union. There were no wound complications or infections. We found 2 cases of radiographic recurrence.

Conclusion: Percutaneous proximal phalanx base metaphyseal closing wedge extracapsular osteotomies of lesser toes to correct coronal plane deformity is useful adjunct to first-ray corrective surgery and is associated with high levels of patient satisfaction.
Click to expand...

Kevin Kirby MVP

Admin2 Administrator Staff Member

drsarbes Well-Known Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Neuropathic pain associated with first metatarsophalangeal joint osteoarthritis

Intra-articular injections of the first metatarsophalangeal joint

Effects of Limitation of Movement of the First Metatarsophalangeal Joint

Dislocation of the second metatarsophalangeal joint in hallux valgus

Foot orthoses for first metatarsophalangeal joint osteoarthritis

Effect by custom-made foot orthoses with added support under the first metatarsophalangeal joint

First metatarsophalangeal joint range in plantar fasciitis

Share This Page