SLR - June 2013 - Ian M. Yarger
Reference: Klein EE, Weil, Jr LS, Weil, Sr LS, Knight J. (2012). The Underlying Osseous Deformity in Plantar Plate Tears: A Radiographic Analysis. Foot Ankle Spec 6: 108-118.
Scientific Literature Review
Reviewed by: Ian M. Yarger, DPM
Residency Program: North Colorado Medical Center Podiatric Medicine and Surgical Residency
Podiatric Relevance: Plantar plate tears are a common cause of forefoot pain and digital deformity seen in the podiatric clinic. This study was designed to determine if a significant correlation exists between pre-operative radiographic measurements and intra-operative pathology among patients surgically treated for a plantar plate tear. A significant correlation between radiographic findings and pathology would allow practitioners to heighten their diagnostic level of suspicion and help guide the surgical intervention of plantar plate tears
Methods: A retrospective analysis was conducted evaluating 88 patients (106 feet) that underwent a second MPJ plantar plate repair using a dorsal approach in conjunction with a Weil osteotomy to gain access to the plantar plate. Inclusion criteria for patients consisted of bilateral weight bearing AP and lateral X-rays available for review and an operative report that included observed pathology of the plantar plate.
Radiographic parameters evaluated include the first intermetatarsal angle, the metatarsus adductus angle, the second and third AP metatarsophalangeal angles, splaying of the second and third toes, evaluation of the metatarsal parabola by three different methods (the arc method described by Hardy and Clapham, the second metatarsal protrusion distance, the method described by Maestro et al.), the first and second lateral declination angles, and the second lateral metatarsophalangeal angle.
Results: Through reviewing the operative reports it was determined that 97 of 106 feet had true plantar plate tears. A significant increase in second metatarsal protrusion angle was found, using two methods of measurement, when comparing the feet of patients with contralateral plantar plate tear. Plantar plate tear was more likely to be observed in patients with an intermetatarsal angle >12, medial deviation of the second toe, and splaying of the digits on radiographic analysis. Although patients with digital splay on AP radiograph were more likely to have a plantar plate tear, no significant difference was present.
Conclusions: Presence of a plantar plate tear did not have significant correlation with pre-operative radiographic measurements of the operative foot. A significant increase in second metatarsal protrusion angle was found when comparing the feet of patients with a contralateral plantar plate tear.