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Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study
Michael J Coughlin1, Shane A Schutt, Christopher B Hirose
1Coughlin Clinic at Saint Alphonsus Medical Center, Boise, ID 83706, USA. footmd@aol.com
Foot & Ankle International
|March 3, 2012
Summary
This study details plantar plate tears in crossover second toe deformities, revealing progressive tears with increasing deformity. An anatomical grading system is proposed for better assessment and treatment of this condition.
Area of Science:
- Orthopedic surgery
- Foot and ankle anatomy
- Biomechanical analysis
Background:
- Surgical treatment for second metatarsophalangeal joint instability has focused on indirect repairs.
- Degeneration and tears of the plantar plate and capsule are rarely documented in crossover toe deformities.
Purpose of the Study:
- To document and describe plantar plate tears in cadaveric specimens with crossover second toe deformities.
- To develop an anatomical grading system for plantar plate tears to aid in assessment and treatment.
Main Methods:
- Dissection of 16 below-knee cadaveric specimens with diagnosed crossover second toe deformity.
- Examination of plantar plate and capsular pathology, including ligamentous disruption.
- Radiographic measurements of MTP-2 and MTP-3 angles before dissection.
Main Results:
- Consistent transverse tears found in the plantar plate proximal to the capsular insertion.
- Tears increased in width and extent with greater deformity, including midsubstance and collateral ligament tears.
- Demographics showed a higher prevalence in older females, with frequent co-occurrence of hallux valgus and rigidus.
Conclusions:
- This study describes the types and extent of plantar plate tears in relation to the severity of crossover second toe deformities.
- Anatomic grading system for progressive plantar plate changes in crossover toe deformities is presented.
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