Evolution of Technology

Plantar Plate Repair

Plantar plate repair has continued to evolve as a treatment option for plate ruptures due to specialized guides and tools used to work within the confined space of the MTP joint. Before the advent of these technologies, fusion procedures using plates and screws were the more common option. While fusion procedures are reliable at relieving pain, patients can no longer move the fused joint, which can lead to different complications later on. As such, opinions that relieved pain and maintained motion were sought.

As plantar plate repair became more popular, different modifications were made. As stated previously, the dorsal approach is becoming more popular as patients can bear weight sooner and have less pain. The inclusion of metatarsal shortening osteotomies became more popular as it was shown to reduce risk of re-rupture. Now, specialized guides and hooks have been developed to allow efficient and safe stitching of the plantar plate, drill holes in the phalanx, and to fix the metatarsal osteotomy site.

Evolution of Procedure

Plantar Plate Repair

Plantar plate repair is performed through an incision over the MTP joint on the top of the foot, or the dorsal surface. The MTP joint is pulled apart to allow for visualization of the underside of the joint where the plate runs.

A tool is used to then separate the plate from the bottom of the metatarsal, allowing for it to be moved around more for repair. Because repair of the plate requires removing some of the injured plate the metatarsal bone needs to be shortened, so an intentional cut is made in the bone in order to shorten it and is then pinned in place. The injured plate is then removed, and stitches are placed in the free end of the remainder of the plantar plate.

Two holes are made in the phalanx and these stitches are passed through those holes and tied down. Screws are then placed in the metatarsal bone to fix the bone cut. This procedure can be quite difficult to perform without specialized tools given the very small space in which all of this work occurs. The use of this dorsal approach to fixing the plate is a more modern twist on classic repair options in which the cut was made on the bottom of the foot.

While the procedure is more difficult from the top of the foot, avoiding cuts and scars on the bottom of the foot should be avoided when possible because there are more nerves and important structures on the bottom of the foot, and scars are more painful on the bottom of the foot.

Evolution of Diagnosis

Plantar Plate Rupture

The plantar plate is a thick band of tissue that runs along the bottom of the joint connecting the toe to the foot, known as the metatarsophalangeal joint or MTP joint. The plantar plate acts as an anchor, holding the phalanx bone in the toe to the metatarsal bone in the foot. Injury to this structure is a common cause of foot pain, especially in endurance athletes, active duty military, and jumping athletes.

This diagnosis is also known as turf toe, although turf toe refers to injury only under the big toe. The most common site for rupture of the plantar plate is under the second toe. While pain is the most common symptom of this injury, other more serious consequences, such as toe deformities and even dislocations, can occur. These injuries can be treated nonoperatively, however operative repair is becoming a more favored option especially as repair of the plantar plate itself is becoming more popular.

Treatment of this injury has evolved over Eme. As stated above, nonoperative treatment was initially the sole option, consisting of cast or boot treatment for several weeks. Fusions of the MTP joint became a solution to this injury especially in patients with deformity or dislocation. However, as our understanding of the anatomy of the plantar plate has improved, so has the popularity of repairing or reconstructing the plate itself.