Abstract
BackgroundInstability of the metatarsophalangeal (MTP) joints of the lesser toes (digiti 2–5) is increasingly being treated by repair of the plantar plate (PP). This systematic review examines the anatomy of the plantar plate of the lesser toes, and the relation between the integrity of the plantar plates of the lesser toes and lesser MTP joint stability.MethodsThe databases of Embase.com, Medline (Ovid), Web of Science, Scopus, Cochrane, Pubmed not medline, Cinahl (ebsco), ProQuest, Lilacs, Scielo and Google Scholar were searched in June 2015 from inception. Studies were included if they were in English, contained primary data, and had a focus on plantar plate anatomy of the lesser toes or on the relationship between integrity of the plantar plate and MTP joint (in)stability. Study characteristics were extracted into two main tables and descriptive anatomical and histological data were summarized into one schematic 3D drawing of the plantar plate.ResultsNine studies were included in this systematic review, of which five addressed plantar plate anatomy as such and four focused directly and indirectly on plantar plate integrity related to MTP joint stability.ConclusionThis is the first systematic review regarding plantar plate anatomy related to MTP joint stability of the lesser toes. This review iterates the importance of plantar plate anatomy and integrity for MTP joint stability, and it delineates the lack of primary data regarding plantar plate anatomy of the lesser toes and MTP joint stability.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-016-0165-2) contains supplementary material, which is available to authorized users.
Highlights
Instability of the metatarsophalangeal (MTP) joints of the lesser toes is increasingly being treated by repair of the plantar plate (PP)
Plantar plate and the collateral ligaments are the main stabilizers of the Metatarsophalangeal joint (MTPJ)
Plantar plate exposure is best obtained by releasing collateral ligaments off of proximal phalanx with a subcapital oblique osteotomy
Summary
Instability of the metatarsophalangeal (MTP) joints of the lesser toes (digiti 2–5) is increasingly being treated by repair of the plantar plate (PP). Further specialization in orthopaedic and podiatric surgery has, amongst others, led to an increased attention for anatomical details, including the interest in the pathophysiology and mechanism of pain beneath the metatarsal heads (metatarsalgia) [1,2,3] Metatarsalgia symptoms such as gradual onset of forefoot pain, edema and a positive drawer sign can be explained by instability of the metatarsophalangeal (MTP) joint [4, 5], MTP joint instability is described as a dorsal subluxation or dislocation of the base of the proximal phalanx over the metatarsal head. The traditional etiology of instability of the lesser MTP joints in the sagittal and/or transverse plane is described in the literature by plantar plate degeneration and rupture [6, 7]. Operative treatment may consist of an indirect reconstruction of the MTP joint in
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