Plantar Plate Rupture
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.
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.
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.
The GRAVITY plantar plate system is a streamlined and easy to use plantar plate repair system made by Wright Medical. Several innovative tools are included in the system including a double barrel drill guide and specialized corkscrew needle drivers that allow for easy preparation of the phalanx and plantar plate, respectively, for repair.
The system also includes very strong ultra-high molecular weight polyethylene suture known as Force Fiber to allow for stout repair of the plate, and easy to use snap off screws for fixing the metatarsal osteotomy. All of these innovations are designed to be easy to use for reliable and strong repair of the plate.