Flexor to Extensor Tendon Transfer and Weil Osteotomy to Treat Grade IV Plantar Plate Tears

Abstract

Purpose: The plantar plate (PP) plays an important role in the stabilization of the lesser metatarsophalangeal (MTP) joints. Lesser toes’ gross deformities are associated with high-grade PP tears, according to the anatomic classification. The aim of this study was to describe the outcomes of 11 patients with PP tears grade IV, treated with the Girdlestone-Taylor-Parrish (GTP) technique, associated with a Weil osteotomy. Materials and Methods: Seventeen MTP joints with instability were treated with the GTP technique associated with a Weil osteotomy. All individuals had forefoot pain and some degree of crossover of the second (or second and third) toe(s) with clinical signs of complete rupture of the PP. Patients were evaluated preoperatively and postoperatively (12-month follow-up) with the American Orthopaedic Foot and Ankle Score, visual analog pain scale, toe purchase, toe elevation, joint stability, and joint congruency. Eight patients (8/11) declared that they were satisfied or very satisfied at the final follow-up. Results: The second MTP joint was the most commonly affected (14/17), followed by the third MTP joint (3/17). Our results reached high positive findings with 15/17 congruent joints at the postoperative radiograph, 8/17 joints presenting no elevation in the postoperative observation, and 17 joints with stability improvements and no major complications. Conclusions: The GTP technique associated with the Weil osteotomy is a reliable option for treating grade IV PP tears. The limitations of our study were the small number of patients analyzed, the absence of a control group, and the minimum follow-up period of 12 months. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.