Plantar Plate Research Articles

Early Functional Outcomes and Complications of Tibial and/or Peroneal Sesamoidectomy Utilizing a Burr Through a Medial Approach.

Sesamoid pathology can lead to significant pain and disability both with activities of daily living and high-impact athletic movements. Sesamoidectomy is a widely used procedure for patients who fail conservative treatment measures. Traditional dorsal or plantar approaches for sesamoidectomy have shown to successfully alleviate pain, but complications were reported. A proposed alternative medial approach using a burr may provide many advantages compared with traditional approaches. This study presents patient outcomes and complications for this technique. This was a retrospective chart review of patients undergoing sesamoidectomy (tibial, peroneal, or both) using a burr through a medial approach to the sesamoid metatarsal articulation. Data collected included patient demographics, radiographic analysis, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. Twenty-seven patients (29 feet) were included. The mean age was 38.4 years followed up for a mean of 30.9 months. VR-12 physical component improved from 35.98 ± 7.86 to 51.34 ± 8.01 (P < .001), FAAM ADL and sport improved from 58.33 ± 16.61 to 83.27 ± 18.28 (P < .001) and 26.37 ± 20.31 to 63.75 ± 29.74 (P < .001), respectively. Patient satisfaction with the treatment was 80.59% ± 27.06%. The overall complication rate was 11 (37.9%) whereas the overall reoperation rate was 4 (13.7%) of 29 feet. Complications included 1 arthrofibrosis, 1 flexor hallucis longus subacute rupture, and 1 asymptomatic hallux valgus. There were no sesamoid excision revisions. Sesamoidectomy using a medial approach with a burr provided significantly improved short-term functional outcomes, 80% patient satisfaction rate, with a relatively acceptable complications rate including 20% persistent pain. The medial approach is familiar to orthopaedic foot and ankle surgeons, provides adequate exposure, and eliminates the possibility of a painful plantar scar while avoiding disruption of the plantar plate, flexor hallucis brevis tendon, and ligamentous structures attached to the sesamoids. Larger studies with long-term follow-up from other centers are needed.

Comparative Evaluation of Effectiveness of Lesser Toe Surgical Correction

INTRODUCTION: The relevance of improving algorithms of surgical correction of lesser toes (SCLT) is due to a high incidence of hammertoe deformity syndrome, its negative impact on the working capacity and quality of life, and to a considerable degree of dissatisfaction of patients with the results of surgical treatment. AIM: To evaluate the effectiveness of an improved SCLT algorithm using a modified fixed B. Helal osteotomy and combined plantar plate (PP) and toe flexor tendon repair. MATERIALS AND METHODS: The prospective study included 167 female patients with a severe deformity of the second lesser toe. In 83 patients of the control group, the stability of the metatarsophalangeal joint was restored through surgical PP repair. In the main group (n = 84), along with elimination of PP defect, the second toe flexor tendon repair was performed. The condition of the second lesser toe before and one year after its surgical correction was evaluated using clinical and X-ray methods and a questionnaire. RESULTS: At the stage of assessing the long-term results of treatment in the main group, the integral score of ACFAS Module 2 scale increased by 63 points relative to the preoperative value, which appeared to be 22 points more (Uemp = 3687, Ucr = 4894, р ˂ 0.01) than a similar change in the control group. One year after surgery, the incidence of the floating toe syndrome and its residual hyperextension in the main group decreased by 10.8% (φ*emp = 0.007, р ˂ 0.05) and 8.8% (φ*emp = 0.016, р ˂ 0.05), respectively. CONCLUSIONS: Application of the improved algorithm permitted to improve the SCLT effectiveness, which was confirmed by a statistically significant improvement of the long-term results of treatment of patients in the main group compared to the control group.

First Cuneo-Metatarsal Arthrodesis (Modified Lapidus) with Plantar Plate for the Treatment of Hallux Valgus: Clinical and Radiological outcomes at One Year Follow-up

IntroductionThe modified Lapidus arthrodesis, involving the first cuneo-metatarsal joint, is a well-established surgical method and widely utilized for treating moderate to severe hallux valgus deformities with hypermobility in the first tarsometatarsal joint. The purpose of this study was to assess the rate of union following the Lapidus procedure using a plantar plate and an immediate full weight-bearing protocol. Secondary objectives included examining radiological corrections and potential associated complications. MethodsA retrospective study included 66 patients (80 feet) who underwent a modified Lapidus procedure for the treatment of hallux valgus associated with hypermobility of the first ray, performed by a single senior surgeon at our institution between May 2013 and November 2019. All patients had a minimum follow-up of 12 months. Patients were clinically assessed at 3 weeks, 3 months, and 1 year. Radiological measurements were taken on weight-bearing dorsoplantar views preoperatively, at 3 months, and at 12 months postoperatively. ResultsBone union was achieved in 79 cases (98.75%). There was one case of non-union, two wound complications (one infection and one dehiscence), two cases of symptomatic hardware requiring hardware removal, and one stress fracture associated with recurrence of hallux valgus that required revision. The mean hallux valgus angle (HVA) improved from 30.5 ° ±10.4 ° to 10.1 ° ±6.6 ° (p < .001), the mean intermetatarsal angle (IMA) improved from 13.4 ° ±3.6 ° to 5.6 ° ±2.9 (p < .001), The average sesamoid position improved from stage 5.9 ± 1.6 to stage 2.6 ± 1.2 (p < .001). The mean shortening of the first metatarsal was 3.6 mm ± 1.8. There was no significant difference between measurements at 3 and 12 months postoperatively. ConclusionModified Lapidus with a planter plate and compression screw is a reliable method of fixation with a high union rate, permit an immediate protected weight bearing and a low complications rate. Level of evidenceIV; Retrospective study

Three-Dimensional MRI of Foot and Ankle: Current Perspectives and Advantages Over 2D MRI

The foot and ankle region, distinguished by its complex and intricate anatomy, is frequently susceptible to injuries, particularly in the context of sports-related activities and fall-related trauma. This article reviews the literature with respect to 3-Dimensional (3D) magnetic resonance imaging (MRI) of foot and ankle. Technical considerations and imaging and interpretation-related advantages and pitfalls will be discussed with relevant case examples. 3D MRI is advantageous over 2-Dimensional (2D) MRI in producing higher spatial resolution in a short duration of time with less partial volume artifacts and in creating structure-specific imaging using multiplanar and curved planar reconstructions. The reader will be able to apply such principles in their practice in obtaining higher-resolution volume imaging of ankle and foot with respect to ligaments, tendons, articular cartilage, plantar fascia, plantar plate, and peripheral nerves for the benefit of their patients and referring physicians.

Ultrasonography-Based Quantitative Evaluation of Second Metatarsophalangeal Joint Instability in Female Patients With Hallux Valgus.

Patients with moderate to severe hallux valgus (HV) sometimes exhibit second metatarsophalangeal (MTP) joint dislocation. Second MTP joint instability due to plantar plate (PP) injury has been suggested as one of the causes. However, there have been no reports that quantitatively evaluate this instability. This study aimed to evaluate second MTP joint instability in patients with HV without dislocation via ultrasonography and investigate its relationship with the presence of PP injury or foot form. Between May 2018 and July 2023, symptomatic female patients with HV without any lesser toe deformity were included in this study. Second MTP joint instability was defined as the dorsal displacement ratio (DDR) of the passively subluxated proximal phalangeal articular surface on the metatarsal head articular surface. The presence of PP injury was assessed using ultrasonography. Foot "form" was determined by measuring standard foot bony angles on weight-bearing foot-ankle radiographs. The relationship between DDR or PP injury and radiographic measurements was investigated. Sixty-four patients (100 feet) were included. The average DDR of the second MTP joint in patients with HV without dislocation was 35.7%. There was an increase in the probability of PP injury, above a cutoff DDR value r of 35.4% (area under the curve = 0.712). The sensitivity, specificity, positive predictive value, and negative predictive value for the presence of PP injury based on this cutoff level were 63.9%, 74.4%, 79.6%, and 56.9%, respectively. Metatarsalgia was reported in 21 feet (21.0%), of which 15 feet (71.4%) showed PP injury. An increase in DDR was weakly associated with increased metatarsus adductus angle and decreased second metatarsal height. In female patients with HV without second MTP dislocation, we found ultrasonographic evidence of second MTP plantar plate injury and joint instability to be a relatively common finding with a high prevalence in those with localized metatarsalgia. Level II, development of diagnostic criteria based on consecutive patients.

Lesão da Placa Plantar: a Importância do Diagnóstico Diferencial

Plantar plate lesions are a common cause of metatarsalgia, a prevalent symptom among the general population and athletes. The plantar plate is a fibrocartilaginous structure located in the plantar side of the feet, that is partly responsible for articular stability. High-impact activities and overuse contribute to plantar plate lesions. The diagnosis is mainly clinical but magnetic resonance imaging and ultrasound can be useful for differential diagnosis. Generally, conservative management, which includes analgesia, shoe adaptation and rehabilitation, is the preferred first treatment option. Surgi¬cal treatment is indicated for severe cases or refractory cases, and post-surgical rehabilitation is mandatory for prognostic optimization.

Walking with individualized 3D-printed minimal footwear increases foot strength and produces subtle changes in unroll pattern

IntroductionThis 5-month follow-up study, involving 66 subjects (38 intervention, 28 control; 34 females, 32 males), evaluated the biomechanics of walking while wearing bespoke, 3D-printed footwear.MethodsA 3D scanner was used to obtain foot shape, which was subsequently modified to yield a suitable instep and additional room in the forefoot and toe areas, to allow for potential shape changes of the foot. Shoes were manufactured using TPU laser sintering. Pre (T0) and post (T1) the intervention, plantar pressures were collected using a plantar pressure plate (3 trials per foot) and toe flexor strength (5 trials per foot) was measured using a dynamometer, for control and intervention groups. Plantar pressure peak patterns and center-of-pressure (CoP) timing was analysed using 2D and 1D Statistical Parametric Mapping, respectively. Toe strength changes were expressed in percent and per individual as: 100 x ((strength@T1strength@T0) / strength@T0).ResultsPeak pressure distribution did not differ between control and intervention populations, or between T0 and T1. Center-of-pressure unroll differed between barefoot and shod conditions at T0 for the intervention group. When barefoot, the intervention group at T1 showed a more lateral CoP in early stance and a more anterior CoP in late stance compared to T0. In the intervention group, toe strength increased significantly by 48.5% between T0 and T1.DiscussionOverall, the results indicate that the bespoke, 3D-printed footwear did not significantly affect peak pressure distribution compared to barefoot walking. However, center-of-pressure patterns during gait were influenced, particularly in the intervention group, with analysis indicative of barefoot subjects' CoP moving faster in early and mid-stance than when shod. Additionally, the intervention led to a significant increase in toe strength. These findings contribute to our understanding of the biomechanical effects of customized 3D-printed footwear and highlight the potential benefits of such interventions in improving foot function and strength.

High-resolution ultrasound and MRI in the evaluation of the forefoot and midfoot.

Radiography is the appropriate initial imaging modality to assess for midfoot and forefoot pathology before turning to advanced imaging techniques. While most lesions of the mid- and forefoot can be diagnosed clinically, the exact nature and severity of the pathology is often unclear. This review addresses the use of the ultrasound, as well as the added value of magnetic resonance imaging, in diagnosing conditions of the midfoot and forefoot. Ultrasound allows a dynamic assessment as well as enabling imaging-guided interventions for diagnostic and therapeutic purposes. Practical tips for optimal examination of this area with ultrasound and magnetic resonance imaging are provided. Metatarsal stress fracture, Chopart's injury, Lisfranc injury, as well as the 1st metatarsophalangeal joint injury and lesser metatarsophalangeal plantar plate injury are injuries unique to the mid- and forefoot. The imaging anatomy of the 1st and lesser metatarsophalangeal joints is reviewed, as such knowledge is key to correctly assessing injury of these joints. Characteristic imaging features of masses commonly encountered in the mid- and forefoot, such as ganglion cyst, Morton neuroma, gouty tophus, plantar fibroma, foreign body granuloma, and leiomyoma are reviewed. The use of ultrasound and magnetic resonance imaging in assessing degenerative and inflammatory joint disorders, and in particular rheumatoid arthritis, of the mid- and forefoot region is also reviewed. In summary, when necessary, most lesions of the mid-and forefoot can be adequately assessed with ultrasound, supplemented on occasion with radiographs, computed tomography, or magnetic resonance imaging.

Turf Toe Injuries in the Athlete: an Updated Review of Treatment Options, Rehabilitation Protocols, and Return-to-Play Outcomes.

First metatarsophalangeal joint sprains or turf toe (TT) injuries occur secondary to forceful hyperextension of the great toe. TT injuries are common among athletes, especially those participating in football, soccer, basketball, dancing, and wrestling. This review summarizes the current treatment modalities, rehabilitation protocols, and return-to-play criteria, as well as performance outcomes of patients who have sustained TT injuries. Less than 2% of TT injuries require surgery, but those that do are typically grade III injuries with damage to the MTP joint, evidence of bony injury, or severe instability. Rehabilitation protocols following non-operative management consist of 3 phases lasting up to 10 weeks, whereas protocols following operative management consist of 4 phases lasting up 20 weeks. Athletes with low-grade injuries typically achieve their prior level of performance. However, among athletes with higher grade injuries, treated both non-operatively and operatively, about 70% are expected to maintain their level of performance. The treatment protocol, return-to-play criteria, and overall performance outcomes for TT injuries depend on the severity and classification of the initial sprain. For grade I injuries, players may return to play once they experience minimal to no pain with normal weightbearing, traditionally after 3-5 days. For grade II injuries, or partial tears, players typically lose 2-4 weeks of play and may need additional support with taping when returning to play. For grade III injuries, or complete disruption of the plantar plate, athletes lose 4-6 weeks or more depending upon treatment strategy.

Early Outcomes Following Plantar Condylectomy and Imbrication of Plantar Plate to Metatarsal Neck for Metatarsalgia and Grade 0 Lesser Toe Metatarsophalangeal Joint Instability

Background: Metatarsalgia and plantar plate tears are characterized by forefoot pain and toe deformity in severe cases. Conservative management may slow progression of symptoms; however, definitive treatment often requires operative intervention. The purpose of this observational study was to evaluate the combination of plantar condylectomy and surgical imbrication of the plantar plate to the metatarsal neck to repair grade 0 plantar plate injuries. Methods: We retrospectively identified 22 patients with metatarsalgia and low-grade plantar plate lesions (grade 0), operated between 2018 and 2021, who underwent operative repair involving plantar metatarsal condylectomy and proximal surgical imbrication of the plantar plate to the metatarsal neck. Fourteen patients underwent concomitant hallux valgus correction. Data collection was performed preoperatively and postoperatively and included Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) scores. Paired Wilcoxon signed-rank tests compared PROMIS PF and PI scores at patients’ preoperative, 6-9-week, 3-4-month, 5-6-month, and ≥9-month follow-up evaluations ( P &lt; .05). Results: Compared to their preoperative visit, patients demonstrated modest improvement in their PROMIS (pain and physical function) scores over the first ≥9 months postoperatively (median 13.0 months). Median preoperative and most recent PROMIS physical function scores were 40.5 (95% CI: 36-49) and 44.5 (95% CI: 40-52), respectively. Median PROMIS pain interference scores changed from 62.5 (95% CI: 56-67) to 56.0 (95% CI: 51-62). Improvement in pain and function was sustained in patients available for postoperative follow-up. Conclusion: In this small, early follow-up series, we found that plantar condylectomy and surgical imbrication of the plantar plate to the metatarsal neck was modestly helpful to treat metatarsalgia and grade 0 plantar plate injuries. Level of Evidence: Level IV, retrospective case series.

Surgical treatment of hammertoe deformity (a literature review)

Aim. To trace developmental origins of surgical treatment of hammertoe deformity and determine the most commonly used methods of its correction based on the published literature analysis. Material and methods. Publications from Google search, electronic databases PubMed, Google Scholar, archives of specialized journals and other relevant sources of scientific and medical information were analyzed. Results. The article covers the developmental origins of surgical treatment of hammertoe deformity both in the historical aspect and at the current level. Attention is paid to soft tissue procedures including tendons, metatarsophalangeal joint capsule, and plantar plate. An overview of operative interventions on the bone apparatus, phalanges and metatarsal bones and the combination of these surgeries is also presented in the article. The disadvantages of the existing surgical treatments, their advantages and the ways for forthcoming research concerning the improvement of surgical care in the treatment of hammertoe deformity are identified. Conclusions. The choice of a particular method of surgical correction between the phalangeal or metatarsal level, the feasibility of combining these interventions with restoring the integrity of the plantar plate and tendon reconstruction, remains debatable. Further study on these issues is a crucial task today for choosing the optimal method of hammertoe deformity correction.

Surgical Treatment of Metatarsalgia and Severe Instability of Lesser Metatarsophalangeal Joints

The main object of this prospective cohort study was to compare surgical treatment options for primary metatarsalgia and the severe instability of lesser metatarsophalangeal joints. The outcomes of triple Weil osteotomy combined with direct plantar plate repair and triple Weil osteotomy, performed with proximal interphalangeal joint arthrodesis, are analyzed and compared. One hundred thirteen patients (117 feet) were enrolled in the study. They were split into 2 groups. In the first group, undergoing Weil osteotomy, combined with the plantar plate repair, good results, including complete pain reduction, elimination of hyperkeratosis, and American Orthopedic Foot and Ankle Society Score improvement, were achieved in 84.7% of the cases. The second group, where the combination of Weil osteotomy and proximal interphalangeal joint K-wire arthrodesis was used, demonstrated good results in 52.4% of the cases. Weil osteotomy, combined with the plantar plate repair, achieves better results in comparison to osteotomy, performed with the interphalangeal joint arthrodesis.

Grade III Turf Toe Injury in a Cowboy.

Turf toe injuries are common, particularly in athletes competing on artificial turf. This debilitating injury and its associated sequelae can affect the long-term performance of athletes and others. In this case is presented an atypical cause for development of grade III turf toe. This case presents an acute injury with significant damage to the plantar first metatarsophalangeal joint, with plantar plate rupture and tibial sesamoid retraction secondary to injury involving working calves on a ranch. The anatomy, mechanism, and associated treatments are reviewed. The anatomical and functional interplay with this injury is discussed.

Indications and possible limitations using medio-plantar plate systems in tarsometatarsal 1 fusions – A cadaveric study

BackgroundThe tarsometatarsal 1 arthrodesis is an adequate treatment for moderate to severe hallux valgus deformity and instability of the first ray. Plantar plating arthrodesis has been shown to provide better mechanical stability and fewer postoperative complications than screw fixation or medial plating. The medio-plantar plate is a new plate design for Lapidus arthrodesis. It could combine the biomechanical advantages of the plantar plate and the anatomical overview of a medial plate. However, the implanted material can cause irritation of the tibialis anterior, which in some cases may require removal of the material. The purpose of this study was to examine the possibility of tendon irritation following medio-plantar first tarsometatarsal joint arthrodesis using cadaveric specimens. MethodsThe study involved the simulated surgical procedure of medio-plantar plate arthrodesis on 30 lower extremities. After the plates were fixed, a thorough examination of the feet was conducted to assess any tendon irritation and to determine a recommendation for placement of the medio-plantar plate based on the Olewnik classification. ResultsIrritation of the tibialis anterior tendon components with the medio-plantar plate depends mainly on the anatomic norm variant, classified according to Olewnik et al. A medio-plantar plate is particularly recommended in TA tendon Olewnik type 3 and type 5. The positioning of a medio-plantar plate in Olewnik type 1 and type 2 tendons depends on the anatomic fit of the medio-plantar plate and the bony configuration of the TMT 1 joint. A large portion of the TA tendon must be detached, so a different plate design may be preferred in these patients. ConclusionsTMT 1 arthrodesis with medio-plantar plating of the first tarsometatarsal joint should be performed considering the anatomic TA tendon variations. Level of evidenceLevel V, Expert Opinion includes Case Reports and Technique Tips.

Biomechanical Comparison of Medio-Plantar and Plantar Plate Fixation for First Tarsometatarsal Joint Arthrodesis.

Plantar plate positioning has been demonstrated as biomechanically superior. However, some operators remain resentful about the morbidity of the surgical approach. To provide improved plate fixation for first tarsometatarsal joint arthrodesis with respect to the tibialis anterior tendon, a medio-plantar plate was developed. The purpose of this biomechanical study was to compare its construct stability to that of a plantar plate construct. Twelve pairs of fresh frozen human specimens were used in a matched pair test. Each pair was fixed with a 4 mm compression screw and either a plantar locking plate or a medio-plantar locking plate. A cantilever beam test was performed in dorsiflexion. Before and after cyclic loading (5000 cycles; 40 N), bending stiffness and relative movements at the joint space were monitored in a quasi-static test including optical motion tracking. Maximum load and bending moment to failure were investigated in a load-to-failure ramp test. The bending stiffness of both groups did not significantly differ before (plantar 49.9 N/mm ± 19.2; medio-plantar 53.9 N/mm ± 25.4, p = 0.43) or after (plantar 24.4 N/mm ± 9.7; medio-plantar 35.3 N/mm ± 22.0, p = 0.08) cyclic loading but decreased significantly in both groups (p < 0.01) after cyclic loading. Relative movement increased significantly during cyclic testing in both groups (p < 0.01) but did not differ significantly between the groups before (p = 0.29) or after (p = 0.16) cyclic loading. Neither load nor bending moment to failure were significantly different (plantar 225 N ± 78, 10.8 Nm; medio-plantar 210 N ± 86, 10.1 Nm, p = 0.61). Both plate constructs provided equivalent construct stability, both being well suited for Lapidus arthrodesis.

The modified Lapidus fusion: a systematic review of biomechanical studies.

The biomechanical characteristics of different techniques to perform the modified Lapidus procedure are controversial, discussing the issue of stability, rigidity, and compression forces from a biomechanical point of view. The aim of this systematic review was to investigate the available options to identify whether there is a procedure providing superior biomechanical results. A comprehensive literature search was performed by screening PubMed, Embase, and Cochrane databases until September 2021. There was a wide heterogeneity of the available data in the different studies. Load to failure, stiffness, and compression forces were summarized and evaluated. Seventeen biomechanical studies were retrieved - ten cadaveric and seven polyurethane foam (artificial bone) studies. Fixation methods ranged from the classic crossed screw approach (n = 5) to plates (dorsomedial and plantar) with or without compression screws (n = 11). Newer implants such as intramedullary stabilization screws (n = 1) and memory alloy staples (n = 2) were investigated. The two crossed screws construct is still a biomechanical option; however, according to this systematic review, there is strong evidence that a plate-screw construct provides superior stability especially in combination with a compression screw. There is also evidence about plate position and low evidence about compression screw position. Plantar plates seem to be advantageous from a biomechanical point of view, whereas compression screws could be better when positioned outside the plate. Overall, this review suggests the biomechanical advantages of using a combination of locking plates with a compression screw.

Plantar plate rupture: aetiology, diagnosis and treatment

The fibrocartilaginous plantar plate is a key static stabilizer of the lesser metatarsophalangeal joints and disruption is associated with metatarsalgia which may progress to significant coronal and sagittal plane deformities, most commonly of the second toe. Chronic attrition is by far the most common mode of injury, though rupture can also occur in acute trauma or in association with erosive rheumatoid arthritis. Focal plantar pain and tenderness, positive drawer test, reduced plantar grip strength and lesser toe deformities are key clinical findings. Diagnosis may be further evaluated with plain radiographs and MRI. Clinical and surgical classification systems have been developed expressing the progression from plantar pain without deformity eventually leading to fixed crossover toe. A range of treatment options have been described in the literature including conservative options, osseous decompression techniques, anatomic plantar plate repair and tendon-transfers. There has been increased focus on anatomic surgical repair as a key treatment strategy over the last decade. Whilst promising results in terms of functional outcome are demonstrated in the literature at the short and mid-term, risks of postoperative stiffness and floating toe deformities should not be ignored when counselling patients regarding surgery and conservative treatment should remain first line.

Long-term Effects of Plantar Plate Therapy for Subtalar Joint Valgus Type for One Case Osteoarthritis of the Knee

There are many research reports showing that the effect of plantar plate on medial knee OA is effective in the short term, but there are few reports that it is effective for a long period of 6 months or longer. Also although there are many studies on plantar plate in the varus type of the subtalar joint, there are few studies in the valgus type of the subtalar joint. In this study, we investigated the long-term effect of wearing a plantar plate that guides the subtalar joint to a neutral position in patients with the subtalar joint valgus type. The case is an elderly female diagnosed with bilateral knee osteoarthritis. The case is an elderly female diagnosed with bilateral knee osteoarthritis. X-ray evaluation was right III, left III in KL grade.The plantar plate was evaluated by comparing the 10 m maximum effort walking time and pain evaluation VAS, the total consumption and the number of steps in one week without and immediately after wearing the plantar plate. In order to examine the long-term effects, functional evaluation was performed 3 months, 6 months, and 12 months after the installation of the plantar plate.As a result, 10m walking time and walking pain improved, suggesting improvement in long-term walking ability after 3 months, 6 months, and 12 months. In addition, SF36.v2, a health-related QOL evaluation scale, total consumption, and number of steps improved, and a weight loss effect was obtained. Based on the above, it is suggested that the manufactured plantar plate is effective for a long period of time. I thought For cases in which the subtalar joint is valgus, a plantar plate that induces varus to the subtalar joint is more suitable than a lateral wedge-shaped plantar plate that induces valgus to the subtalar joint.

Investigation of Impact Absorption Function of Carbon Plantar Plate for Low Arch Foot

At present, it cannot be said that the impact absorption function of the truss structure of the foot arch during static standing has been elucidated.In this study, the spring constant and the viscous damping coefficient are calculated and examined in order to compare the shock absorption characteristics of the low-arch foot seen in flat feet and the characteristics of the normal-arch foot.In addition, in order to supplement the spring constant and viscous damping coefficient for one case of low arch foot, we investigated using a carbon plantar plate. Six types of carbon plantar plates were compared, with heels and without heels, with 2 layers, 3 layers, and 4 layers.As a result, the low arch foot showed a low spring constant and a high viscous damping coefficient. In the comparison of 6 types of carbon plantar plates, the one with heel showed high spring constant and viscous damping coefficient. The value closest to the normal arch was the 3-layer carbon plantar plate without heel.It was thought that the low-arch foot had a reduced spring function that absorbs impact. The carbon plantar plate with heel cup clearly shows high values of spring constant and viscous damping coefficient, which means that hard to sink the heel.The reason for this is presumed to be the influence of the soft tissue of the heel is likely to collapse due to the heel couter.The carbon plantar plate used this time was not able to compensate for the impact class function of the normal arch foot, so further examination was necessary. However, this research has a small number of subjects, so it is necessary to increase the number of subjects and investigate again. As a future task, we will consider increasing the number of subjects.

Proximal Plantar Plate of Lesser Toe Metatarsophalangeal Joint Vascular Supply.

The plantar plate is a major stabilizing structure of the metatarsophalangeal (MTP) joint with instability frequently occurring after a tear or attenuation of this structure. Commonly, a McGlamry elevator is used to strip the plantar plate from the plantar surface of the metatarsal to improve exposure of the MTP joint. The anatomy of the proximal plantar plate and vascular consequence of stripping the plantar plate from the metatarsal is not yet well understood. The purpose of this study is to describe the proximal attachment of the plantar plate anatomically and quantify the relative contribution of blood supply to the proximal plantar plate from both the metatarsal and the plantar fascia. For anatomic evaluation, 6 lower extremity cadaver specimens without any gross evidence of foot and ankle deformity were utilized. For imaging analysis, 16 fresh frozen human adult cadaveric lower extremity specimens were used for this study, resulting in 35 MTP joints without deformity and 11 lesser MTP joints with cockup and/or crossover deformities. The specimens were prepared as described previously by Finney et al.5. From gross anatomic dissection, the plantar plate origin consists of a stout fibrous pedicle distinct from the surrounding synovial-type tissue that firmly anchors the plantar plate to the metatarsal. Based on nano-computed tomographic imaging, an average of 63.5% of the vascular supply to the proximal portion of the plantar plate entered from the metatarsal pedicle. The remaining 36.5% of the vascular supply entered from the plantar fascia. The proximal attachment of the plantar plate includes a stout fibrous pedicle anchoring the proximal portion of the plantar plate to the notch between the medial and lateral plantar condyles of the metatarsal head. The vascular supply of the proximal plantar plate is supplied from both the metatarsal pedicle and plantar fascia. Level III, retrospective comparative study.