Plantar plate radiofrequency and Weil osteotomy for subtle metatarsophalangeal joint instablity

Abstract

Objective: Demonstrate the results obtained in the treatment of patients with plantar plate tear grade zero and one treated with arthroscopic radiofrequency of the plantar plate injuries combined with Weil osteotomy. Methods: Between January 2009 and June 2011, data for 19 patients (35 joints) with instability of the lesser metatarsophalangeal were gathered. They underwent clinical, radiological and arthroscopic evaluation (diagnostic and therapeutic) of each affected joint and had their data recorded. Results: Among our patients, 73% were female and 85% of then reported wearing high heels. The average age and postoperative follow-up was 59 years and 20 months, respectively. The mean American Orthopaedics Foot and Ankle Society score (AOFAS) score rosefrom 53 points preoperatively to 92 points in the postoperatively and the Visual Analogue Pain Scale (VAS) obtained average value of eight points preoperatively which decreased to zero postoperatively (p<0.001). During the preoperative evaluation, none of the patients had stable joint and over 97% were classified as having grade 1 of instability (<50% subluxation). After treatment, 83% of the metatarsophalangeal joints become stable (degree of instability 0) with over 97% of congruent joints. Conclusion: Arthroscopic application of radiofrequency in combination with Weil osteotomy promotes functional improvement, pain relief and return of joint stability in patients with grades 0 an 1 plantar plate lesions.