Plantar Plate Repair Using a Direct Plantar Approach: An Outcomes Analysis

Direct plantar plate repair using a plantar approach has been described previously, but with few reports of the outcomes or clinical results. The purpose of the present study was to determine the outcomes of this technique. We performed a retrospective analysis of patients who had undergone direct plantar plate repair with or without concomitant Weil osteotomy and a prospective patient-reported subjective outcomes analysis. Ultimately, 131 patients (144 toes) were included, and the response rate for the mailed surveys was 53.5% (77 of 144 toes). The clinical outcomes reported a well-aligned toe in 87.1% of cases, with a recurrence rate of 7.6% (11 of 144) and a revision rate of 2.8% (4 of 144). Statistically significant improvement in the overall modified Foot Function Index (p < .001) and subscale scores for pain (p < .001), disability (p < .001), and activity limitation (p = .001) were noted postoperatively compared with the preoperative data. The median postoperative visual analog pain scale level reported at survey completion was 2.0 (range 0.0 to 10.0; mean ± standard deviation 2.3 ± 2.6). Despite the modified Foot Function Index scores, the patient satisfaction questionnaire data reported mixed results. Our modified Foot Function Index results demonstrated that this approach provides excellent postoperative pain relief, improvement of associated disability, and improvement in activity limitations. The importance of managing patient expectations is acknowledged secondary to the discrepancy with the patient satisfaction data and the modified Foot Function Index results. Further prospective study is warranted to compare this technique with alternate dorsal approaches for plantar plate repair with and without associated commercially available suture passing systems.