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

Lesser Metatarsophalangeal Joint Instability: Arthroscopic Treatment Alternatives

Instability of the lesser toes metatarsophalangeal (MTP) joints is a common forefoot problem and can present as metatarsalgia, synovitis, and lesser toe deformities. The plantar plate contributes to MTP joint stability through its interaction with the plantar aponeurosis, and plantar plate insufficiency is the primary cause of MTP joint instability. Conservative treatment options, including the use of nonsteroidal anti-inflammatory medications, intra-articular steroid injections, orthosis, and accommodative shoe modifications, generally provide only temporary relief and do not effectively halt the progression of deformity in most cases. In this article, the different arthroscopic treatment alternatives are discussed including plantar plate tenodesis.

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.