Metatarsophalangeal joint instability and plantar plate lesions: morphological and clinical study

Abstract

Objective: A lesser toe metatarsophalangeal instability with a crossover deformity is a commonly seen forefoot problem, usually in women greater than 50 years-old, and it is often in association with a bunion deformity. The plantar plate is the main static stabilizer of the metatarsophalangeal joints. Different authors have proposed classifications to define instability of the metatarsal phalangeal joints, but all describe only clinical progression of the deformity. The aim of this study was to present our clinical and anatomic observations on lesser metatarsophalangeal plantar plate lesions and to propose a new grading method Methods: From January 2009 to June 2010, we prospectively treated 28 patients (55 joints) with lesser metatarsophalangeal joint instability. All of them had initial complaints of acute forefoot pain with the subsequent development of deformity and instability of the metatarsophalangeal joints. All patients were clinically evaluated by images (plain radiographs and magnetic resonance imaging), and by metatarsophalangeal joint arthroscopy. Results: With these data, a direct correlation between the clinical staging and the anatomical grading for plantar plate dysfunction of each patient was determined (pConclusions: Our anatomic and clinical classification combines clinical findings and anatomical aspects of the plantar plate tears.