Correction of Crossover Toe Deformity by Plantar Plate Tenodesis and Arthroscopic Release of Lumbrical

Claw Toe With Dislocated Second Metatarsophalangeal Joint: Treated by Plantar Plate Tenodesis and Release of Collateral Ligaments

Claw toe deformity of the second toe is a common forefoot deformity faced by foot and ankle surgeons. Frequently, it develops as the result of plantar plate insufficiency and subsequent metatarsophalangeal (MTP) joint instability. As the disease deteriorates, the MTP joint can be dislocated. Reduction of the MTP joint without metatarsal osteotomy seems to be a logical approach unless there is excessively long second metatarsal. However, adequate periarticular soft-tissue release including the dorsal capsule, collateral ligaments and extensor tendon is needed to reduce the intra-articular pressure and minimize the risk of joint degeneration. The purpose of this Technical Note is to describe the details of plantar plate tenodesis and release of collateral ligaments for correction of claw second toe associated with dislocation of the metatarsophalangeal joint.

Correction of Severe Crossover Toe Deformity By Plantar Plate Tenodesis, Arthroscopic Release of Lumbrical and Plication of Lateral Capsuloligamentous Complex

Plantar plate deficiency is the major cause of instability of the metatarsophalangeal joint, and plantar plate tenodesis can provide dynamic stabilization of the plantar plate. In case of crossover toe deformity, incorporation of arthroscopic release of the medial capsuloligamentous complex and the lumbrical tendon can eliminate the medial deforming force. However, in case of severe deformity, the lateral capsuloligamentous complex is attenuated. The purpose of this Technical Note is to incorporate the technique of arthroscopic plication of the lateral capsuloligamentous complex into the technique of plantar plate tenodesis and arthroscopic release of the medial capsuloligamentous complex and the lumbrical tendon.