Patient-reported outcomes after dorsal approach plantar plate repair with nine year follow up

Despite reports of favorable short- and mid-term outcomes with direct plantar plate repair, there is scarce data in the literature with follow up greater than two years.

To examine long-term clinical and patient-reported outcomes with isolated 2nd metatarsophalangeal joint (MTPJ) dorsal approach plantar plate repair STUDY DESIGN: Prospective cohort of consecutive patients METHODS: Data were longitudinally collected from patients undergoing 2nd MTPJ dorsal approach plantar plate repair for metatarsalgia in our practice from November 2011 to March 2012. Outcomes included a structured clinical assessment, VAS for pain and Foot and Ankle Outcome Scores (FAOS) at two years and 9+ years post-operatively.

Fifty-three consecutive patients (53 joints; 50 women, 3 men) with mean age of 58.2 ± 9.8 years completed a two-year follow up exam demonstrating normalized toe position, strength, range of motion and stability. Eighteen patients developed post-operative dorsal joint arthrofibrosis and 16 elected for a minor percutaneous soft tissue release on the toe prior to this follow up visit. FAOS scores were significantly improved in 3 of 5 domains at two years. Thirty-two (32/53, 60%) patients completed assessments at a median 9.6 years post-operatively. At this time, scores were significantly improved from both baseline and 2 years in all 5 FAOS domains. Seventy-eight percent (25/32) of patients reported they were satisfied or extremely satisfied and would have the procedure again.

The 2nd MTPJ dorsal approach plantar plate repair appears to be safe and effective at alleviating pain and restoring function at long-term follow up.