Plantar Plate Repair using Suture Anchors for Chronic Plantar Plate Rupture of the first Interphalangeal Joint in a Pediatric Patient: A Case Report.

Abstract

Injuries of the great toe are common sports-related injuries; however, isolated traumatic plantar plate tears at the interphalangeal (IP) joint are relatively rare. Here, we present a pediatric case of a chronic plantar plate tear of the IP joint of the great toe that was difficult to diagnose definitively, which delayed surgical treatment. An 11-year-old girl was injured when she collided with her right great toe while using a jump box during gymnastics. She felt pain in her great toe that progressively worsened despite conservative treatment at an initial clinic, and she experienced hyperextension of the IP joint. She was referred to our outpatient clinic because of diagnostic difficulty and increased symptoms, such as pain and swelling of the plantar side of her right great toe. Physical examination revealed swelling and tenderness on the plantar aspect of the IP joint and the impossibility of active flexion of the IP joint. The passive range of motion was 35° during extension. Ultrasonography revealed a low-echoic area on the plantar plate on the phalangeal side. Thus, we diagnosed the patient with a chronic plantar plate tear of the IP joint of the right great toe and performed surgical treatment 8 months after its onset. The plantar plate ruptured at the insertion of the proximal phalanx; however, the insertion of the distal phalanx remained intact. The plantar plate was repaired using suture anchors, and excellent short-term postoperative results were obtained at the 1-year follow-up. Isolated plantar plate rupture is difficult to diagnose definitively in the acute phase because of the lack of specific findings on physical and radiographic examinations. Plantar plate rupture should be suspected as a differential diagnosis in patients with great toe injuries due to axial load and hyperextension forces. Plantar plate repair using suture anchors may be a useful option for treating plantar plate tears of the IP joint of the great toe when its insertion into the distal phalanx is preserved, even during the chronic phase.