Plantar plate repair of the second metatarsophalangeal joint: technique and tips.

Since diagnostic arthrography of the second metatarsophalangeal joint (MTPJ) has been popularized by Karpman and MacCollum (1), the relationship between plantar plate integrity and digital instability is better understood. Yao et al (2) suggested that an arthrogram of the second MTPJ exhibiting opacification of the flexor tendon sheath is pathognomonic for a plantar plate tear. The plantar plate is the principal stabilizer of the MTPJ and any compromise to its integrity creates instability to the joint (3–5). The plantar plate stabilizes the lesser toes via the plantar fascia windlass mechanism. Insufficiency of the plantar plate is implicated in the pathogenesis of chronic MTPJ and toe subluxation/ dislocation. Primary repair of the plantar plate has been gaining attention recently and has been advocated for tears or ruptures that result in instability to the MTPJ (6–8). Powless and Elze (7) have included plantar plate tears in their classification system of lesser MTPJ capsular tears. The technique for isolated primary plantar plate repair of the lesser MTPJ is limited in the literature.