Sequential dissection for exposure of the second metatarsophalangeal joint

Area of Science:

• Orthopedic surgery
• Foot and ankle anatomy
• Surgical approaches

Background:

• Second metatarsophalangeal (MTP) joint instability is common.
• Plantar plate pathology is a known cause of MTP joint instability.
• Limited literature exists on the surgical exposure and repair of plantar plate lesions.

Purpose of the Study:

• To determine the dissection required for exposing the plantar plate via a dorsal approach.
• To evaluate the feasibility of repairing plantar plate lesions through this approach.

Main Methods:

• Cadaveric dissection of eight second MTP joints using a dorsal approach.
• Sequential dissection steps were performed.
• Measurements of plantar plate exposure were taken using fluoroscopy and digital photography after each step.

Main Results:

• A dorsal capsulotomy combined with collateral ligament release from the proximal phalanx base and a subcapital oblique metatarsal osteotomy yielded significant plantar plate exposure (8-8.5 mm).
• Releasing collateral ligaments from the metatarsal head or elevating the plantar plate provided minimal additional exposure.
• This technique may help preserve the metatarsal head's blood supply by avoiding certain releases.

Conclusions:

• Plantar plate exposure is achievable through collateral ligament release off the proximal phalanx and a subcapital oblique osteotomy.
• Avoiding collateral ligament or plantar plate release may help minimize disruption to the metatarsal head's blood supply.