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Leung YT, Lui TH. Claw Toe With Dislocated Second Metatarsophalangeal Joint: Treated by Plantar Plate Tenodesis and Release of Collateral Ligaments. Arthrosc Tech 2022; 11:e1695-e1702. [PMID: 36311323 PMCID: PMC9596388 DOI: 10.1016/j.eats.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/07/2022] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
| | - Tun Hing Lui
- Address correspondence to Dr. Tun Hing Lui, M.B.B.S. (H.K.), F.R.C.S. (Edin.), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Rd., Sheung Shui, NT, Hong Kong SAR, China.
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Lui TH, Chan YLC. Correction of Severe Crossover Toe Deformity By Plantar Plate Tenodesis, Arthroscopic Release of Lumbrical and Plication of Lateral Capsuloligamentous Complex. Arthrosc Tech 2021; 10:e1921-e1927. [PMID: 34401234 PMCID: PMC8355197 DOI: 10.1016/j.eats.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/16/2021] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong,Address correspondence to Tun Hing Lui, M.B.B.S. (HK), F.R.C.S. (Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
| | - Yi Lok Charis Chan
- Department of Orthopaedics and Traumatology, United Christian Hospital, Hong Kong, China
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Lui TH, Ng CK. Correction of Crossover Toe Deformity by Plantar Plate Tenodesis and Arthroscopic Release of Lumbrical. Arthrosc Tech 2021; 10:e1621-e1626. [PMID: 34258213 PMCID: PMC8252812 DOI: 10.1016/j.eats.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 02/03/2023] Open
Abstract
Plantar plate deficiency is the major cause of instability of the metatarsophalangeal joint. As the joint subluxates dorsally, the lumbrical is tethered on the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover toe deformity. Release of the lumbrical is needed to achieve adequate medial soft-tissue release. Plantar plate tenodesis has been described to correct the deformity by suturing the plantar plate to the extensor digitorum longus tendon. The purpose of this Technical Note is to incorporate the technique of arthroscopic release of the lumbrical tendon into the technique of plantar plate tenodesis.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, Hong Kong
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
| | - Chun Kiu Ng
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Tsuen Wan, Hong Kong
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Lui TH, LiYeung LL. Modified double plantar plate tenodesis. Foot Ankle Surg 2017; 23:62-67. [PMID: 28159046 DOI: 10.1016/j.fas.2016.05.313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 02/25/2016] [Accepted: 05/03/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Metatarsophalangeal joint instability of the lesser toe can cause acquired toe deformity. Plantar plate deficiency is the major pathology. Plantar plate repair can stabilize the joint but may result in iatrogenic transverse plane toe deformity in correction of claw toe deformity. Limited toe extension can be resulted after correction of crossover toe deformity by plantar plate tenodesis and extensor digitorum brevis transfer. A modification of the technique is proposed. MATERIALS AND METHODS The clinical outcomes of 10 patients with the modified procedure performed were assessed. RESULTS The correction was full in all toes with no recurrence. CONCLUSION The modified technique can stabilize the metatarsophalangeal joint and correct lesser toe deformity without the need of tendon transfer, osteotomy or sophisticated instrumentation.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region.
| | - L L LiYeung
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region.
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Lui TH. Correction of Crossover Toe Deformity by Arthroscopically Assisted Plantar Plate Tenodesis. Arthrosc Tech 2016; 5:e1273-e1279. [PMID: 28149725 PMCID: PMC5263059 DOI: 10.1016/j.eats.2016.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/20/2016] [Indexed: 02/03/2023] Open
Abstract
Plantar plate deficiency is the major pathology causing metatarsophalangeal joint instability. As the joint subluxates dorsally, the lumbrical is tethered at the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover toe deformity. Plantar plate repair or reconstruction is a logical surgical treatment option. This can be performed through a dorsal or plantar approach. The purpose of this technical note is to report a minimally invasive technique of crossover toe deformity correction by suturing the plantar plate to the extensor tendon. It is indicated for symptomatic crossover toe deformity that is not responsive to nonsurgical treatment. It is contraindicated if the metatarsophalangeal joint is degenerated, destructed, or dislocated, or there is interdigital neuroma at the sides of the deformed toe, or the deformity is caused by bony deformities of the metatarsal head or the proximal phalanx.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Abstract
The clinical application of small joint arthroscopies (metatarsophalangeal joint, Lisfranc joint, Chopart joint, and interphlangeal joint) in the foot has seen significant advancements in the past decades. This article reviews the clinical indications, technical details, outcomes, and potential complications of small joint arthroscopies of the foot.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong 999077, China.
| | - Chi Pan Yuen
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong 999077, China
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Lesser metatarsal phalangeal joint arthroscopy: anatomic description and comparative dissection. Arthroscopy 2014; 30:971-9. [PMID: 24835840 DOI: 10.1016/j.arthro.2014.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 03/12/2014] [Accepted: 03/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this article is to describe the normal arthroscopic anatomy of the lesser metatarsophalangeal (MTP) joints and compare it with that seen in open dissection in cadaveric models. METHODS We performed arthroscopic examination of 18 MTP joints of 6 normal fresh frozen feet. The second, third, and fourth MTP joints were studied because of the higher incidence of pathologic conditions found in these joints. During arthroscopy, each anatomic structure identified was named and marked with different colored sutures using straight suture needles. After the arthroscopic procedure of identification and marking, each MTP joint was dissected, and all the anatomic structures were grossly identified. With these data, the correlation between the arthroscopic and the direct visualization of a normal MTP joint was established. RESULTS Considering the joint regions, we found that the examination accuracy of the medial gutter was 91%, whereas the central joint accuracy reached 100% and the accuracy of the lateral gutter was 98%. The overall arthroscopic accuracy for the lesser MTP joints was 96%. CONCLUSIONS There is a high level of anatomic accuracy at the lesser MTP joint with arthroscopy. CLINICAL RELEVANCE The high overall level of anatomic accuracy of lesser MTP joint arthroscopy (96%) allows us to consider this resource as a valuable tool in the diagnosis and treatment of these joints, expanding the spectrum of indications using this method.
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Klein EE, Weil L, Weil LS, Knight J. The underlying osseous deformity in plantar plate tears: a radiographic analysis. Foot Ankle Spec 2013; 6:108-18. [PMID: 23091286 DOI: 10.1177/1938640012463060] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Plantar plate tears can cause pain and deformity of the forefoot. The purpose of this study is to correlate common radiographic findings with observed intra-operative pathology in patients with plantar plate pathology. METHODS Bilateral weight-bearing radiographs were reviewed for 88 patients (106 feet) who underwent surgical repair of suspected plantar plate pathology. Parameters reviewed included the first intermetatarsal angle, the metatarsus adductus angle, the second and third metatarsophalangeal angles, splaying of the second and third toes, evaluation of the metatarsal parabola by 3 different methods, the first and second lateral declination angles, and the second lateral metatarsophalangeal angle. RESULTS Of 106 feet, 97 had intra-operative plantar plate tears. The radiographs of patients with plantar plate tears had an increased amount of digital splay on the anteroposterior radiograph compared to patients without pathology. For patients with unilateral plantar plate pathology, the metatarsal parabola of the symptomatic foot was compared with that of the asymptomatic foot. A significantly increased second metatarsal protrusion distance as measured by 2 different methods was noted in the symptomatic foot. Odds ratios revealed that patients with an intermetatarsal angle >12, medial deviation of the second toe, and splaying of the digits were more likely to be diagnosed with a plantar plate tear intra-operatively. CONCLUSION Although radiographs do not definitively diagnose plantar plate tears, understanding osseous forefoot architecture will aid with diagnosis in the absence of other osseous pathology. Furthermore, these data suggest that parabola should be corrected to maintain long-term correction of plantar plate pathology. LEVEL OF EVIDENCE Prognostic, Level II.
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Affiliation(s)
- Erin E Klein
- Weil Foot and Ankle Institute, Des Plaines, IL 60016, USA
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Barg A, Courville XF, Nickisch F, Bachus KN, Saltzman CL. Role of collateral ligaments in metatarsophalangeal stability: a cadaver study. Foot Ankle Int 2012; 33:877-82. [PMID: 23050713 DOI: 10.3113/fai.2012.0877] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lesser metatarsophalangeal joint (MTPJ) instability is a common complaint. The role each of the collateral structures play in maintaining joint stability is unknown. METHODS Twenty-six fresh-frozen cadaver lesser MTPJ's were tested for instability with the amount of force necessary to translate the joint 3 mm dorsally. Specimens were tested with 1) intact collateral ligaments, 2) transected accessory collateral or proper collateral ligaments (ACL or PCL), 3) repaired ACL or PCL, 4) transected ACL and PCL, 5) repaired ACL and PCL, and 6) transferred interosseous (IO) tendon. Student t-tests were performed to test for statistical significance (p value less than 0.05). RESULTS The mean force required for 3 mm of dorsal displacement was 25 ± 13 N (range, 11 to 52 N) in the 26 specimens. Transecting either the ACL alone or the ACL and PCL led to the most instability versus transecting the PCL alone. Repairing both ligaments improved stability. The IO tendon transfer was comparable to the direct repair of the PCL but was inferior to the direct repair of the ACL. CONCLUSION Both ACL and PCL have a stabilizing effect on the MTPJ. However, the ACL was more important since primary transection of the ACL led to more instability and additional transection of the PCL in an ACL deficient model did not lead to significantly more instability. CLINICAL RELEVANCE Direct repairs of both structures improved the stability of the joint but not back to normal. IO tendon transfer is a possible adjunct to collateral ligament repairs, but in itself is not sufficient to restore stability.
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Affiliation(s)
- Alexej Barg
- University of Utah, Orthopaedics, Salt Lake City, UT 84108, USA
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Kernbach KJ. Hammertoe surgery: arthroplasty, arthrodesis or plantar plate repair? Clin Podiatr Med Surg 2012; 29:355-66. [PMID: 22727377 DOI: 10.1016/j.cpm.2012.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In cases of painful complex hammertoe deformity, there is no single approach that can be used in all circumstances. If conservative care fails, surgical management may include interphalangeal joint arthroplasty, arthrodesis, and/or plantar plate repair. The best and most pragmatic surgical plan must be patient-centered, taking the age, activity level, expectations of the patient, and precise etiology of the hammertoe deformity into account.
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Affiliation(s)
- Klaus J Kernbach
- Kaiser North Bay Consortium Residency Program, Department of Podiatry, Kaiser Foundation Hospital, 975 Sereno Drive, Vallejo, CA 94589, USA.
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Abstract
Surgery of the lesser toes is a difficult balancing act, and revision procedures are challenging. It is vastly preferable that the correct procedure be chosen for the correct patient and performed properly from the outset. The flow charts below (Figs. 23–25) are not a rigid protocol, but rather the authors’ personal algorithm, based on their own experience, which may help other surgeons facing a stiff, deformed or flail toe to make a reasoned decision.
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Affiliation(s)
- Matthew C Solan
- London Foot and Ankle Centre, Hospital of St John and St Elizabeth, 80 Grove End Road, London NW8 9NH, UK.
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Correction of crossover deformity of second toe by combined plantar plate tenodesis and extensor digitorum brevis transfer: a minimally invasive approach. Arch Orthop Trauma Surg 2011; 131:1247-52. [PMID: 21387136 DOI: 10.1007/s00402-011-1293-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Indexed: 02/09/2023]
Abstract
PURPOSE To study the efficacy and safety of the combined plantar plate tenodesis and extensor digitorum brevis transfer in correction of claw toe deformity. METHODS Between 2007 and 2008, 11 patients (13 feet) underwent combined plantar plate tenodesis and EDB transfer for the correction of crossover second toe deformity. The clinical and radiological results were studied. RESULTS There was no more crossover toe deformity in all patients. Two patients had residual mild residual claw toe deformity. The lateral metatarsophalangeal angle in preoperative weight-bearing radiograph averaged 53° ± 5°. The postoperative lateral metatarsophalangeal angle averaged 23° ± 6°. The dorsoplantar metatarsophalangeal angle in preoperative weight-bearing radiograph averaged -9° ± 4°. The postoperative dorsoplantar metatarsophalangeal angle averaged 2° ± 4°. CONCLUSIONS Combined plantar plate tenodesis and extensor digitorum brevis transfer is an effective procedure to correct crossover second toe deformity. This is a relatively simple procedure and can be preformed through small incisions with minimal soft tissue dissection. LEVEL OF EVIDENCE Level 3 therapeutic study.
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