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1.
Foot Ankle Int ; 44(1): 75-80, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36539967

RESUMO

BACKGROUND: The plantar plate is a major stabilizing structure of the metatarsophalangeal (MTP) joint with instability frequently occurring after a tear or attenuation of this structure. Commonly, a McGlamry elevator is used to strip the plantar plate from the plantar surface of the metatarsal to improve exposure of the MTP joint. The anatomy of the proximal plantar plate and vascular consequence of stripping the plantar plate from the metatarsal is not yet well understood. The purpose of this study is to describe the proximal attachment of the plantar plate anatomically and quantify the relative contribution of blood supply to the proximal plantar plate from both the metatarsal and the plantar fascia. METHODS: For anatomic evaluation, 6 lower extremity cadaver specimens without any gross evidence of foot and ankle deformity were utilized. For imaging analysis, 16 fresh frozen human adult cadaveric lower extremity specimens were used for this study, resulting in 35 MTP joints without deformity and 11 lesser MTP joints with cockup and/or crossover deformities. The specimens were prepared as described previously by Finney et al.5. RESULTS: From gross anatomic dissection, the plantar plate origin consists of a stout fibrous pedicle distinct from the surrounding synovial-type tissue that firmly anchors the plantar plate to the metatarsal. Based on nano-computed tomographic imaging, an average of 63.5% of the vascular supply to the proximal portion of the plantar plate entered from the metatarsal pedicle. The remaining 36.5% of the vascular supply entered from the plantar fascia. CONCLUSION: The proximal attachment of the plantar plate includes a stout fibrous pedicle anchoring the proximal portion of the plantar plate to the notch between the medial and lateral plantar condyles of the metatarsal head. The vascular supply of the proximal plantar plate is supplied from both the metatarsal pedicle and plantar fascia. LEVEL OF EVIDENCE: Level III, retrospective comparative study.


Assuntos
Ossos do Metatarso , Articulação Metatarsofalângica , Placa Plantar , Adulto , Humanos , Estudos Retrospectivos , Articulação Metatarsofalângica/anatomia & histologia , Ossos do Metatarso/anatomia & histologia , Dedos do Pé
2.
Clin Podiatr Med Surg ; 39(3): 411-419, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35717059

RESUMO

The fibrocartilaginous component of the plantar plate offers stability at the metatarsophalangeal joint. In conjunction with the attachments of the deep transverse metatarsal ligaments and collateral ligaments, the plantar plate complex resists tensile forces anchored by the plantar fascia and compression forces under the metatarsal heads.


Assuntos
Ligamentos Colaterais , Ossos do Metatarso , Articulação Metatarsofalângica , Placa Plantar , , Humanos , Ossos do Metatarso/cirurgia , Articulação Metatarsofalângica/cirurgia , Placa Plantar/cirurgia
3.
Clin Podiatr Med Surg ; 39(3): 451-459, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35717062

RESUMO

The plantar plate is a critical structure involved in stabilizing the metatarsophalangeal joint. Its disruption can not only be painful for the patient but also may lead to subsequent structural deformities. There are several conservative treatment modalities available to help mitigate symptoms including splinting, offloading, and intraarticular injections. That being said, once the pathology progresses to advanced stages, these treatments are not efficacious. Reported success with conservative treatment modalities is limited to case studies and series with a low level of clinical evidence. As such, this represents an area where further investigation is needed to evaluate the true efficacy of conservative treatment and to allow for development of a more standardized approach.


Assuntos
Instabilidade Articular , Articulação Metatarsofalângica , Placa Plantar , Humanos , Instabilidade Articular/cirurgia , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Osteotomia , Placa Plantar/cirurgia
4.
Clin Podiatr Med Surg ; 39(3): 489-502, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35717065

RESUMO

The plantar plate is a vital structure for maintaining lesser metatarsophalangeal joint (MPJ) stability. Its primary role is to provide static stabilization of the MPJs, working in conjunction with the long and short flexor and extensor tendons. When insufficiency or attenuation of the plantar plate occurs, a sagittal plane deformity will slowly develop, eventually leading to a "crossover toe" transverse plane deformity. Coughlin coined this descriptive term to describe the later stages of deformity, most commonly affecting the second MPJ. Shortly after, Yu and Judge elaborated on this condition describing it as "predislocation syndrome," an inflammatory condition affecting the plantar plate causing pain and instability, which could progress to subluxation at the MPJ.


Assuntos
Deformidades do Pé , Instabilidade Articular , Articulação Metatarsofalângica , Placa Plantar , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Articulação Metatarsofalângica/cirurgia , Placa Plantar/cirurgia , Tendões
5.
Orthop Clin North Am ; 53(3): 349-359, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35725043

RESUMO

The plantar plate is a known stabilizer of the lesser toe metatarsophalangeal (MTP) joint. MTP instability is a known common cause of metatarsalgia, most commonly in the second toe. In the last decade, clinical staging and anatomic grading mechanisms have been published to guide the surgeons on the treatment of MTP instability; this has also led to an understanding of how plantar plate tears relate to MTP joint instability. Direct surgical repair of the plantar plate has been described, short-term outcomes have been published, and the results are not perfect, but promising with respect to patient satisfaction and pain relief.


Assuntos
Instabilidade Articular , Articulação Metatarsofalângica , Placa Plantar , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Articulação Metatarsofalângica/cirurgia , Placa Plantar/cirurgia , Dedos do Pé/cirurgia
6.
Eur J Radiol ; 152: 110315, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35533558

RESUMO

BACKGROUND: Previous literature has suggested both MRI and ultrasound can accurately diagnose plantar plate tears. There is a significant cost difference between these two modalities, sparking interest for which should be the preferred method for diagnosis. PURPOSE: The purpose of this study was to examine the diagnostic accuracy of MRI and dynamic, musculoskeletal ultrasound for lesser metatarsal plantar plate injuries using a systematic review and meta-analysis. METHODS: MEDLINE, CINAHL, and Clinicaltrials.gov were searched thru May 2020. We included studies evaluating the diagnostic accuracy of MRI or ultrasound for detecting plantar plate tears, using intraoperative confirmation as the gold standard comparison. Sensitivity and specificity were obtained and pooled from included studies. Summary receiver operating curves were formed for each diagnostic test to compare accuracy. Study quality was assessed using the QUADAS-2 scoring system. RESULTS: Eleven studies met our inclusion criteria, representing 227 plantar plates for MRI and 238 plantar plates for ultrasound. MRI displayed a pooled sensitivity of 89% (95% CI 0.84, 0.93) and specificity of 83% (95% CI 0.64, 0.94). Ultrasound displayed a sensitivity and specificity of 95% (95% CI 0.91, 0.98) and 52% (95% CI 0.37, 0.68), respectively. CONCLUSION: MRI was superior to ultrasound in diagnosing plantar plate injuries overall, however, ultrasound was more sensitive than MRI, suggesting a negative ultrasound would likely rule out a plantar plate injury in the presence of an equivocal physical exam. Determining the grade of the injury is best served with MRI which can provide added insight into the joint's supporting structures (e.g. collateral ligaments) and integrity.


Assuntos
Placa Plantar , Humanos , Imageamento por Ressonância Magnética , Placa Plantar/diagnóstico por imagem , Placa Plantar/lesões , Sensibilidade e Especificidade , Ultrassonografia
7.
Einstein (Sao Paulo) ; 20: eAO6543, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35476080

RESUMO

OBJECTIVE: The magnetic resonance imaging diagnostic criteria for a complete tear of metatarsophalangeal plantar plate are well-established. However, more subtle abnormalities can also occur and be a source of pain. The objective of this study is to determine the prevalence of degenerative plantar plate injuries in patients with metatarsalgia who underwent forefoot magnetic resonance imaging and describe the main abnormalities found. The hypothesis is that mild capsular fibrosis will have high sensitivity but low specificity for plantar plate degenerative injuries. METHODS: A retrospective cross-sectional study was conducted with 85 patients (105 feet) with metatarsalgia who underwent forefoot magnetic resonance imaging using a specific protocol to study metatarsophalangeal plantar plate. The experiment observer classified second toe plantar plate as normal, complete rupture or degenerative lesion and described the main magnetic resonance imaging findings. RESULTS: A normal plantar plate was observed in 75 (71.4%) of the 105 feet assessed, in 25 (24%) feet there were degenerative plantar lesions, and in 5 (4.6%) feet there were complete ruptures. Degenerative injury of the plantar plate was best identified in coronal short axis intermediate-weighted images, with high sensitivity (92%). Pericapsular fibrosis below the intermetatarsal ligament was identified in 96% of cases, with high sensitivity (96%) for diagnosis of degenerative plantar plate injury. CONCLUSION: Degenerative lesions of the metatarsophalangeal plantar plate were more prevalent than complete ruptures and were best viewed in coronal short axis intermediate-weighted sequences. Pericapsular fibrosis below the intermetatarsal ligament was the indirect finding most strongly associated with degenerative plantar plate injury.


Assuntos
Metatarsalgia , Placa Plantar , Estudos Transversais , Fibrose , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Metatarsalgia/diagnóstico por imagem , Placa Plantar/diagnóstico por imagem , Placa Plantar/lesões , Estudos Retrospectivos , Ruptura
8.
Clin Podiatr Med Surg ; 39(2): 167-185, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365322

RESUMO

Lesser toe plantar plate injuries at the metatarsophalangeal (MTP) joint are a common source of metatarsalgia. Chronic pain with weight-bearing is the common presentation of lesser toe instability. Deformity occurs when the plantar plate is torn or attenuated. Crossover toe and MTP instability often occur with multiplane deformity, most commonly with dorsal contracture of the second toe and medial drift over the Hallux. In this article, the authors present a comprehensive stepwise approach to diagnosing and treating plantar plate injuries using both dorsal and plantar approach techniques.


Assuntos
Deformidades do Pé , Instabilidade Articular , Articulação Metatarsofalângica , Placa Plantar , Deformidades do Pé/diagnóstico , Humanos , Instabilidade Articular/diagnóstico , Articulação Metatarsofalângica/cirurgia , Placa Plantar/cirurgia , Dedos do Pé
9.
J Foot Ankle Surg ; 61(5): 1114-1118, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35283034

RESUMO

Recognition of metatarsophalangeal joint plantar plate injuries has improved over time as the condition has become more widely understood and identified. With the diagnosis of a plantar plate injury as a subset of metatarsalgia becoming more common place, there are multiple surgical options that have been utilized to address the condition. Direct repair of the plantar plate has emerged as the treatment of choice for foot surgeons with a tendency to favor a direct dorsal approach for the repair. We performed a systematic review and meta-analysis using preferred reporting items for systematic reviews and meta-analysis guidelines, to determine the magnitude of change that can be expected in visual analog scale pain and American Orthopedic Foot and Ankle Society scores postoperatively. A total of 12 studies involving 537 plantar plate tears were included who underwent direct repair of the plantar plate through either a dorsal (10 articles) or plantar approach (2 articles). Summary estimates were calculated which revealed improvement in visual analog scale pain (pooled mean change of -5.01 [95%CI -5.36, -4.66] pre-to postoperative) and improvement in American Orthopedic Foot and Ankle Society scores (pooled postoperative mean improvement 40.44 [95%CI 37.90, 42.97]) of patients within the included studies. Random effects models were used for summary estimates. I2 statistic was used to assess for heterogeneity. We concluded there is a predictable level of improvement in pain and function in patients undergoing a direct dorsal approach plantar plate repair with follow-up out to 2 years.


Assuntos
Instabilidade Articular , Metatarsalgia , Articulação Metatarsofalângica , Placa Plantar , Humanos , Instabilidade Articular/cirurgia , Articulação Metatarsofalângica/lesões , Articulação Metatarsofalângica/cirurgia , Osteotomia , Placa Plantar/lesões , Placa Plantar/cirurgia
10.
BMC Musculoskelet Disord ; 23(1): 11, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980055

RESUMO

BACKGROUND: The plantar plate is an important static stabilizer of the lesser metatarsophalangeal joints, and disruptions of the plantar plate can lead to significant instability and lesser toe deformities. In recent years, direct plantar plate repair has been proposed. Although direct repair via a dorsal approach is attractive, a torn plantar plate is small and difficult to access using regular instruments in a restricted operative field. METHODS: In this report, a unique method for plantar plate repairs was used to repair various configurations of plantar plate tears with standard operative instruments that are available in most operating rooms. RESULTS: Using this method, 10 patients underwent plantar plate repairs, and the mean follow-up period was 24 (range, 14-38) months. The mean visual analog scale score for pain preoperatively was 4.1 (range, 0-6) and decreased to 0.6 (range, 0-3) at last follow-up. Postoperatively, the mean visual analog scale score for satisfaction was 9.6 (range, 8-10) and the mean American Orthopedic Foot and Ankle Society forefoot score was 88.8 (range, 75-100). CONCLUSIONS: Our study proposes an inexpensive and versatile method for plantar plate repair via a dorsal approach that uses standard operative instruments. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04949685 . July 2, 2021 - Retrospectively registered, LEVEL OF CLINICAL EVIDENCE: 4.


Assuntos
Deformidades do Pé , Instabilidade Articular , Articulação Metatarsofalângica , Placa Plantar , Humanos , Osteotomia , Placa Plantar/cirurgia
11.
Foot Ankle Surg ; 28(1): 1-6, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33478807

RESUMO

BACKGROUND: Splay of the forefoot reflects the loss of tension in the soft tissues and indicates failure of the biomechanics of the tie-bar system. By identifying and quantifying the soft tissue structures involved in the destruction of forefoot stability we could increase the understanding of forefoot pathologies. METHODS: We investigated the transverse forefoot laxity on healthy feet, feet with forefoot pathology and cadaveric feet undergoing sequential dissection. RESULTS: Statistical difference in transverse laxity was seen between healthy feet (n = 160) and feet with symptomatic forefoot pathology requiring surgery (n = 29). Presence of lesser ray pathology is associated with increased transverse laxity. For the dissected cadaveric feet (n = 9) sequential sectioning the plantar plate causes a progressive evolution of transverse laxity. The repair of plantar plates greatly improves transverse stability. CONCLUSIONS: Forefoot pathology causes increased transverse laxity. In case of a major transverse laxity of the forefoot a plantar plate lesion should be suspected.


Assuntos
Hallux Valgus , Placa Plantar , Fenômenos Biomecânicos , , Humanos
12.
J Neurosci ; 41(41): 8494-8507, 2021 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-34452938

RESUMO

Previous studies have shown that infiltration of capsaicin into the surgical site can prevent incision-induced spontaneous pain like behaviors and heat hyperalgesia. In the present study, we aimed to monitor primary sensory neuron Ca2+ activity in the intact dorsal root ganglia (DRG) using Pirt-GCaMP3 male and female mice pretreated with capsaicin or vehicle before the plantar incision. Intraplantar injection of capsaicin (0.05%) significantly attenuated spontaneous pain, mechanical, and heat hypersensitivity after plantar incision. The Ca2+ response in in vivo DRG and in in situ spinal cord was significantly enhanced in the ipsilateral side compared with contralateral side or naive control. Primary sensory nerve fiber length was significantly decreased in the incision skin area in capsaicin-pretreated animals detected by immunohistochemistry and placental alkaline phosphatase (PLAP) staining. Thus, capsaicin pretreatment attenuates incisional pain by suppressing Ca2+ response because of degeneration of primary sensory nerve fibers in the skin.SIGNIFICANCE STATEMENT Postoperative surgery pain is a major health and economic problem worldwide with ∼235 million major surgical procedures annually. Approximately 50% of these patients report uncontrolled or poorly controlled postoperative pain. However, mechanistic studies of postoperative surgery pain in primary sensory neurons have been limited to in vitro models or small numbers of neurons. Using an innovative, distinctive, and interdisciplinary in vivo populational dorsal root ganglia (DRG) imaging (>1800 neurons/DRG) approach, we revealed increased DRG neuronal Ca2+ activity from postoperative pain mouse model. This indicates widespread DRG primary sensory neuron plasticity. Increased neuronal Ca2+ activity occurs among various sizes of neurons but mostly in small-diameter and medium-diameter nociceptors. Capsaicin pretreatment as a therapeutic option significantly attenuates Ca2+ activity and postoperative pain.


Assuntos
Cálcio/metabolismo , Capsaicina/administração & dosagem , Gânglios Espinais/metabolismo , Dor Pós-Operatória/metabolismo , Dor Pós-Operatória/prevenção & controle , Ferida Cirúrgica/metabolismo , Vias Aferentes/química , Vias Aferentes/efeitos dos fármacos , Vias Aferentes/metabolismo , Animais , Feminino , Gânglios Espinais/química , Membro Posterior/inervação , Membro Posterior/metabolismo , Hiperalgesia/metabolismo , Hiperalgesia/prevenção & controle , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Placa Plantar/química , Placa Plantar/inervação , Placa Plantar/metabolismo , Fármacos do Sistema Sensorial/administração & dosagem
13.
JBJS Case Connect ; 11(2)2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34170855

RESUMO

CASE: A 56-year-old male patient sustained a traumatic cuboid medioplantar dislocation associated with a lateral cuneiform fracture. The patient was treated with open reduction and fixation using 2 temporary Kirschner wires. During surgery, the plantar ligament apparatus was found to be almost intact and the reduction was easily performed. At the last follow-up visit, the patient's functional outcomes were excellent. CONCLUSIONS: Traumatic cuboid medioplantar dislocation associated with lateral cuneiform fracture usually requires surgical treatment. The authors conclude the integrity of the plantar ligament apparatus may play a role in facilitating the reduction.


Assuntos
Fraturas Ósseas , Luxações Articulares , Placa Plantar , Ossos do Tarso , Fios Ortopédicos , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade
14.
J Athl Train ; 56(5): 461-472, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34000019

RESUMO

CONTEXT: Arch height is one important aspect of foot posture. An estimated 20% of the population has pes planus and 20% has pes cavus. These abnormal foot postures can alter lower extremity kinematics and plantar loading and contribute to injury risk. Ankle bracing is commonly used in sport to prevent these injuries, but no researchers have examined the effects of ankle bracing on plantar loading. OBJECTIVE: To evaluate the effects of ankle braces on plantar loading during athletic tasks. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 36 participants (11 men, 25 women; age = 23.1 ± 2.5 years, height = 1.72 ± 0.09 m, mass = 66.3 ± 14.7 kg) were recruited for this study. INTERVENTION(S): Participants completed walking, running, and cutting tasks in 3 bracing conditions: no brace, lace-up ankle-support brace, and semirigid brace. MAIN OUTCOME MEASURE(S): We analyzed the plantar-loading variables of contact area, maximum force, and force-time integral for 2 midfoot and 3 forefoot regions and assessed the displacement of the center of pressure. A 3 × 3 mixed-model repeated-measures analysis of variance was used to determine the effects of brace and foot type (α = .05). RESULTS: Foot type affected force measures in the middle (P range = .003-.047) and the medial side of the foot (P range = .004-.04) in all tasks. Brace type affected contact area in the medial midfoot during walking (P = .005) and cutting (P = .01) tasks, maximum force in the medial and lateral midfoot during all tasks (P < .001), and force-time integral in the medial midfoot during all tasks (P < .001). Portions of the center-of-pressure displacement were affected by brace wear in both the medial-lateral and anterior-posterior directions (P range = .001-.049). CONCLUSIONS: Ankle braces can be worn to redistribute plantar loading. Additional research should be done to evaluate their effectiveness in injury prevention.


Assuntos
Traumatismos do Tornozelo , Braquetes , Pé Chato , Placa Plantar/fisiologia , Pé Cavo , Suporte de Carga/fisiologia , Tornozelo/fisiologia , Traumatismos do Tornozelo/etiologia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/prevenção & controle , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Pé Chato/complicações , Pé Chato/diagnóstico , Pé Chato/fisiopatologia , Humanos , Masculino , Corrida/fisiologia , Pé Cavo/complicações , Pé Cavo/diagnóstico , Pé Cavo/fisiopatologia , Caminhada/fisiologia , Adulto Jovem
15.
J Foot Ankle Res ; 14(1): 35, 2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910602

RESUMO

BACKGROUND: Diabetes mellitus is associated with changes in soft tissue structure and function. However, the directionality of this change and the extent to which either tissue thickness or stiffness contributes to the pathogenesis of diabetes-related foot ulcerations is unclear. Hence, this systematic review aims to summarise the existing evidence for soft tissue structural differences in the feet of people with and without diabetes. METHODS: In compliance with MOOSE and PRISMA guidelines, AMED, CINAHL, MEDLINE, ProQuest Health & Medical Collection, ProQuest Nursing & Allied Health Database, and Web of Science electronic databases were systematically searched for studies published from database inception until 1st October 2020 [Prospero CRD42020166614]. Reference lists of included studies were further screened. Methodological quality was appraised using a modified critical appraisal tool for quantitative studies developed by McMaster University. RESULTS: A total of 35 non-randomised observational studies were suitable for inclusion. Within these, 20 studies evaluated plantar tissue thickness, 19 studies evaluated plantar tissue stiffness, 9 studies evaluated Achilles tendon thickness and 5 studies evaluated Achilles tendon stiffness outcomes. No significant differences in plantar tissue thickness were found between people with and without diabetes in 55% of studies (11/20), while significantly increased plantar tissue stiffness was found in people with diabetes in 47% of studies (9/19). Significantly increased Achilles tendon thickness was found in people with diabetes in 44% of studies (4/9), while no significant differences in Achilles tendon stiffness were found between people with and without diabetes in 60% of studies (3/5). CONCLUSIONS: This systematic review found some evidence of soft tissue structural differences between people with and without diabetes. However, uncertainty remains whether these differences independently contribute to diabetes-related foot ulcerations. The heterogeneity of methodological approaches made it difficult to compare across studies and methodological quality was generally inadequate. High-quality studies using standardised and validated assessment techniques in well-defined populations are required to determine more fully the role of structural tissue properties in the pathogenesis of diabetes-related foot ulcerations.


Assuntos
Tendão do Calcâneo/fisiopatologia , Diabetes Mellitus/fisiopatologia , Pé Diabético/fisiopatologia , Placa Plantar/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto
16.
Oper Orthop Traumatol ; 33(5): 422-429, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-33704511

RESUMO

OBJECTIVE: Reconstruction of the plantar plate to stabilize a dislocated or instable lesser metatarsophalangeal joint using a dorsal approach in combination with a Weil osteotomy. INDICATIONS: Dislocated or instable lesser metatarsophalangeal joint with rupture of the plantar plate. CONTRAINDICATIONS: Infection, circulatory disorders, symptomatic degenerative arthritis lesser metatarsophalangeal joint. SURGICAL TECHNIQUE: Weil osteotomy using a dorsal approach. Temporary dislocation of the metatarsal head as proximal as possible. Inspection of the plantar plate. Assessment and classification of type and extent of the rupture. Suturing of the plantar plate to the plantar bases of the proximal phalanx. Fixation of the Weil osteotomy with correction of the metatarsal alignment. POSTOPERATIVE MANAGEMENT: Weight bearing in a postoperative shoe as tolerated. X­ray control 6 weeks postoperative. Full weight bearing in a conventional shoe after bony consolidation. RESULTS: A total of 23 surgical reconstructions of the plantar plate (complete plantar plate repair) between 12/2012 and 10/2014 were performed. The mean follow-up was 18.6 (12-30) months. Five secondary dislocations were observed: one deep postoperative infection, one early dislocation of unknown cause, one secondary dislocation caused by severe hallux valgus recurrence, one massive foreign body reaction to the non-resorbable sutures, and one late secondary dislocation occurred between 6 weeks and 1 year postoperative. Normal function of the reconstructed joint was achieved in 13 of the 23 reconstructions (57%). A reduced toe purchase was observed in 3 reconstructions (13%). A floating-toe resulted after 7 reconstructions (30%).


Assuntos
Ossos do Metatarso , Articulação Metatarsofalângica , Placa Plantar , Humanos , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Osteotomia , Placa Plantar/diagnóstico por imagem , Placa Plantar/cirurgia , Resultado do Tratamento
17.
Foot Ankle Int ; 42(7): 944-951, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33563043

RESUMO

BACKGROUND: Recent surgical techniques have focused on anatomic repair of lesser toe metatarsophalangeal (MTP) plantar plate tears, yet it remains unknown whether the plantar plate has the biological capacity to heal these repairs. Therefore, a better understanding of the plantar plate vasculature in response to injury may provide further insight into the potential for healing after anatomic plantar plate repair. Recently, a study demonstrated that the microvasculature of the normal plantar plate is densest at the proximal and distal attachments. The purpose of this study was to compare the intact plantar plate microvasculature network to the microvasculature network of plantar plates in the presence of toe deformity using similar perfusion and nano-computed tomographic (CT) imaging methods. METHODS: Seven fresh-frozen human cadaveric lower extremities with lesser toe deformities including hammertoe or crossover toe were perfused using a barium solution. The soft tissues of each foot were counterstained with phosphomolybdic acid (PMA). Then using nano-CT imaging, the second through fourth toe metatarsophalangeal joints of 7 feet were imaged. These images were then reconstructed, plantar plate tears were identified, and 11 toes remained. The plantar plate microvasculature for these 11 toes was analyzed, and calculation of vascular density along the plantar plate was performed. Using analysis of variance (ANOVA), this experimental group was compared to a control group of 35 toes from cadaveric feet without deformity and the vascular density compared between quartiles of plantar plate length proximal to distal. A power analysis was performed, determining that 11 experimental toes and 35 control toes would be adequate to provide 80% power with an alpha of 0.05. RESULTS: Significantly greater vascular density (vascular volume/tissue volume) was found along the entire length of the plantar plate for the torn plantar plates compared to intact plantar plates (ANOVA, P < .001). For the first quartile of length (proximal to distal), the vascular density for the torn plantar plates was 0.365 (SD 0.058) compared to 0.281 (SD 0.036) for intact plantar plates; in the second quartile it was 0.300 (SD 0.044) vs 0.175 (SD 0.025); third quartile it was 0.326 (SD 0.051) vs 0.117 (SD 0.015); and fourth (most distal) quartile was 0.600 (SD 0.183) vs 0.319 (SD 0.082). CONCLUSION: Torn plantar plates showed increased vascular density throughout the length of the plantar plate with an increase in density most notable in the region at or just proximal to the attachment to the proximal phalanx. Our analysis revealed that torn plantar plates exhibit neovascularization around the site of a plantar plate tear that does not exist in normal plantar plates. CLINICAL RELEVANCE: The clinical significance of the increased vascularity of torn plantar plates is unknown at this time. However, the increase in vasculature may suggest that the plantar plate is a structure that is attempting to heal.


Assuntos
Deformidades do Pé , Síndrome do Dedo do Pé em Martelo , Articulação Metatarsofalângica , Placa Plantar , Humanos , Articulação Metatarsofalângica/cirurgia , Placa Plantar/cirurgia , Dedos do Pé
18.
Khirurgiia (Mosk) ; (1): 62-68, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395514

RESUMO

OBJECTIVE: To improve postoperative outcomes in patients with distal Achilles tendon rupture by using of a new method of surgical treatment. MATERIAL AND METHODS: The authors proposed a new method to restore the Achilles tendon for its distal rupture (within 2 cm from attachment to the calcaneus). This approach implies forming a canal in the calcaneus and minimally invasive harvesting of the plantar tendon. At the next stage, the plantar tendon is passed through the canal of the calcaneus in U-shaped fashion and proximal part of Achilles tendon with maximum approximation of its fragments and imposing of interrupted sutures on the plantar and Achilles tendons to hold the position. The end of plantar tendon is used to reinforce damaged area. The schemes and surgical stages are shown in the figures. We reported a patient with distal Achilles tendon rupture and postoperative outcome. RESULTS: An above-mentioned approach was applied in 26 patients. The control group consisted of 21 patients who underwent recovery with anchor fixers. Early and long-term postoperative results, as well as adverse events were analyzed in both groups. Biomechanical parameters of gait were evaluated from the standpoint of evidence-based medicine using podography and functional myography. We confirmed an advantage of treatment in the main group.


Assuntos
Tendão do Calcâneo , Procedimentos Ortopédicos , Traumatismos dos Tendões , Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Calcâneo/cirurgia , Doença Crônica , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Ortopédicos/métodos , Placa Plantar/transplante , Ruptura/cirurgia , Âncoras de Sutura , Técnicas de Sutura , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento
19.
Skeletal Radiol ; 50(8): 1513-1525, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33423073

RESUMO

Lesser metatarsophalangeal (MTP) joint plantar plate tears are a common and increasingly recognised cause of metatarsalgia, MTP joint instability and forefoot deformity. Increased interest in early accurate diagnosis of plantar plate tears follows recent surgical innovations allowing direct plantar plate repair. The purpose of this review is to describe the ultrasound features of normal lesser MTP joint plantar plates and to characterise and illustrate the direct and indirect ultrasound findings of plantar plate tears. Lesser MTP joint plantar plate tears are most commonly located at the 2nd MTP joint, involving the lateral distal plantar plate insertion with variable propagation medially and proximally. The most common ultrasound appearance of a plantar plate tear is a discrete partial or full thickness hypoechoic defect in the plate substance. Flattening and attenuation or non-visualisation of the plantar plate represent more extensive tears. Dynamic imaging with toe dorsiflexion improves visualisation of tears and augments MTP joint subluxation. A common indirect finding is pericapsular fibrosis along the MTP joint capsule adjacent to a plantar plate tear, which requires differentiation from Morton's neuroma, and key distinguishing features at ultrasound are described. Other indirect findings include the cartilage interface sign, flexor tendon subluxation onto the metatarsal head or medial to the midline, flexor tenosynovitis, proximal phalangeal enthesophytes or avulsion and MTP joint synovitis. Ultrasound offers several advantages over MR imaging but requires a meticulous ultrasound examination, and optimisation of scanning technique is described.


Assuntos
Instabilidade Articular , Ossos do Metatarso , Articulação Metatarsofalângica , Placa Plantar , Humanos , Imageamento por Ressonância Magnética , Articulação Metatarsofalângica/diagnóstico por imagem , Placa Plantar/diagnóstico por imagem
20.
Clin Anat ; 34(7): 1002-1008, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32996633

RESUMO

The aim of this study was to elucidate the morphological characteristics of the lateral Lisfranc ligament in a large sample. This investigation examined 100 legs from 50 cadavers. Each of the lower limbs was dissected to identify the plantar aspect of the transverse metatarsal arch, and morphological characteristics of the lateral plantar ligament were assessed, including the length, width, and thickness of the fiber bundles. The majority of plantar ligaments originated from the base of M5 and the plantar aspect of the lateral cuneiform (LC). The lateral plantar ligament could be classified into three types: Type I, a band-like fiber bundle originating from the base of M5 to the LC (41%); Type II, originating from the base of M5 and the plantar aspect of LC and mostly connected the blending the fiber bundles of the tibialis posterior (TP) and long plantar ligament (LPL) (21%); and Type III, with no ligaments originating from the base of M5 and plantar aspect of the LC (38%). The morphological characteristics of Type I lateral plantar ligament were as follows: length, 31.8 ± 3.7 mm; width, 2.3 ± 1.0 mm; and thickness, 0.2 ± 0.3 mm. The morphology of the lateral plantar ligament showed variation, originating from the base of M5 and the plantar aspect of LC most commonly, but this was not the case in 38% of limbs. The findings suggest that the lateral plantar ligament might play a role in the transverse tarsal arch, indicating a cooperative mechanism with the TP and LPL.


Assuntos
Placa Plantar/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino
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