Role of Collateral Ligaments in Metatarsophalangeal Stability: A Cadaver Study

Barg, Alexej; Courville, Xan F.; Nickisch, Florian; Bachus, Kent N.; Saltzman, Charles L.

doi:10.3113/fai.2012.0877

Cited by 42 publications

(16 citation statements)

References 32 publications

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“…Our novel surgical procedure consists of CL reconstruction without PP repair. Recently, a cadaveric study demonstrated that repair of the CL improved joint stability [29]. The clinical and radiological outcomes in the present study support the conclusions of the cadaveric study.…”

Section: Discussionsupporting

confidence: 88%

Surgical reduction and ligament reconstruction for chronic dorsal dislocation of the lesser metatarsophalangeal joint associated with hallux valgus

Shima

Okuda

Yasuda

et al. 2015

Journal of Orthopaedic Science

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Section: Discussionsupporting

confidence: 88%

Surgical reduction and ligament reconstruction for chronic dorsal dislocation of the lesser metatarsophalangeal joint associated with hallux valgus

Shima

Okuda

Yasuda

et al. 2015

Journal of Orthopaedic Science

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“…Большинство методов восстановления подошвенной связки плюснефалангового сустава проводятся с рассечением связочного коллатерального аппарата, что нарушает биомеханику движений и усиливает их нестабильность [30]. Нередко даже при коррекции деформации оси первой плюсневой кости сохраняются и прогрессируют симптомы метатарзалгии [31].…”

Section: способы восстановления подошвенной связки плюснефалангового unclassified

The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment

2017

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This paper presents a comprehensive review on the current concept of the diagnosis and treatment of central metatarsalgia on the basis of medical literature analyses. Metatarsalgia is the term for pain in the forefoot. This is a set of symptoms corresponding to a wide range of diseases. Central metatarsalgia is a kind of metatarsalgia which arises from structural-functional changes that lead to excessive pressure in the area of metatarsal heads. The data analysis demonstrated that presently various types of osteotomies of metatarsal bones are the main surgical treatment options with the chance of complication ranging from 6 to 50%. Weil-osteotomy is known to be the most popular type of osteotomy for treatment of central metatarsalgia. The most common complication of Weil-osteotomy is floating toe, the one that doesn’t contact with the supporting surface. In case Weil-osteotomy and intraphalangeal arthrodesis with trans acticular fixation are both performed, the complication of floating toe increases up to 50%. When Weil osteotomy, plantar plate repair, extensor digitorum longum tendon lengthening and triple Weil-osteotomy are performed simultaneously, the complication rate is 15% approximately which is much lower. Using combined osteotomy techniques as well as taking into account structural-functional pathologic changes of the forefoot and ligaments repair of metatarsalphalangeal joint will ensure the most successful development of surgical treatment techniques for central metatarsalgia.

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“…The plantar plate inserts firmly to the bases of the proximal phalanges ( Figure 2) and serves as an important distal attachment of the plantar fascia [6]. It is anchored to the distal metaphyseal region of the lesser metatarsals by the collateral ligaments and each plantar plate apparatus is coupled together by the deep transverse metatarsal ligament [7]. The plantar plate is in direct contact with the lesser metatarsal heads during gait and functions as the primary static stabilizer of the lesser MTPJs [8].…”

Section: Anatomymentioning

confidence: 99%

Plantar Plate Pathology: A Review Article

Maier¹

2016

MOJOR

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Submit Manuscript | http://medcraveonline.com this condition including metatarsalgia, pre-dislocation syndrome, lesser metatarsophalangeal joint (MTPJ) instability, and crossover toe deformity [1]. It is important to recognize that these diagnoses are common manifestations of plantar plate dysfunction.The second MTPJ is the most frequently affected with the incidence of this condition highest among women over the age of 50 [2]. Interestingly, patients with rheumatoid arthritis tend to demonstrate plantar plate insufficiency at the fourth and fifth MTPJs more so than the second [3]. Other deformities are often present in conjunction such as hallux abducto valgus (Figure 1), hallux rigidus, and hallux varus [4]. This review will focus on plantar plate anatomy, pathology, and the diagnosis, treatment and outcomes of plantar plate tears. AnatomyThe plantar plate is a fibrocartilaginous, intracapsular structure composed of primarily type 1 collagen measuring approximately 20mm, 16mm, and 2-5mm in length, width, and thickness, respectively [5]. The plantar plate inserts firmly to the bases of the proximal phalanges ( Figure 2) and serves as an important distal attachment of the plantar fascia [6]. It is anchored to the distal metaphyseal region of the lesser metatarsals by the collateral ligaments and each plantar plate apparatus is coupled together by the deep transverse metatarsal ligament [7]. The plantar plate is in direct contact with the lesser metatarsal heads during gait and functions as the primary static stabilizer of the lesser MTPJs [8]. The structure and function is analogous to the menisci of the knee by resisting compressive forces during weight bearing [5]. PathophysiologyThe etiology of plantar plate pathology is multifactorial [9][10][11][12]. Any biomechanical abnormality leading to overload of the lesser metatarsals may result in plantar plate deterioration and subsequent MTPJ instability; this includes a long second metatarsal, first ray hypermobility, hallux abducto valgus, hallux rigidus, and pes planus [4,9].When the plantar plate ruptures and dorsal displacement of the proximal phalanx occurs, the ability of the intrinsic and extrinsic musculature to provide dynamic stability of the lesser MTPJs is impaired. Changes of the biomechanical axes of the primary flexors of the lesser MTPJs (the interosseous muscles) in addition to the lumbricals, flexor digitorum brevis, and flexor digitorum longus result in a defective restraint to prevent dorsal subluxation of the toe [10]. The chronic inflammatory state of synovial tissues in rheumatoid arthritis and other systemic arthritic diseases causes soft tissue and bone destruction which progresses to joint insufficiency and often frank dislocation of the lesser MTPJs [11]. Less commonly, acute trauma produces this condition [12]. DiagnosisPhysical examination is paramount in the diagnosis of plantar plate dysfunction. Forefoot pain and specifically discomfort involving the metatarsal heads can arise from a variety of pathologies. During physical examinat...

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Role of Collateral Ligaments in Metatarsophalangeal Stability: A Cadaver Study

Abstract: 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.

Cited by 42 publications

References 32 publications

Surgical reduction and ligament reconstruction for chronic dorsal dislocation of the lesser metatarsophalangeal joint associated with hallux valgus

Surgical reduction and ligament reconstruction for chronic dorsal dislocation of the lesser metatarsophalangeal joint associated with hallux valgus

The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment

Plantar Plate Pathology: A Review Article

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