Hammertoes pp 241-253 | Cite as

Plantar Plate Repair via a Plantar Approach

  • Eric G. Powell
  • Melinda A. Bowlby
  • Jeffrey C. Christensen


Plantar plate dysfunction of the lesser digits can occur after a toe injury or from repetitive stress. The plantar plate underlying the second toe is most commonly affected and morphology can range from attenuation to an obvious tear. Plantar plate tears can be diagnosed from clinical exam and confirmed with advanced imaging. The pathological morphology can demonstrate a discrete tear or attenuation of the plate. The direct plantar approach allows for visualization and primary repair.


Plantar plate tear Plantar plate surgery Plantar approach Hammertoe Reverse windlass Crossover toe 


  1. 1.
    Bouché RT, Heit EJ. Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal joints: preliminary observations. J Foot Ankle Surg. 2008;47:125–37.CrossRefGoogle Scholar
  2. 2.
    Klein EE, Weil L Jr, Weil LS Sr, et al. Clinical examination of plantar plate abnormality: a diagnostic perspective. Foot Ankle Int. 2013;34:800–4.CrossRefGoogle Scholar
  3. 3.
    Yu GV, Judge MS, Hudson JR, Seidelmann FE. Predislocation syndrome: progressive subluxation/dislocation of the lesser metatarsophalangeal joint. J Am Podiatr Med Assoc. 2002;92:182–99.CrossRefGoogle Scholar
  4. 4.
    Suero EM, Meyers KN, Bohne WHO. Stability of the metatarsophalangeal joint of the lesser toes. A cadaveric study. J Orthop Res. 2012;30:1995–8.CrossRefGoogle Scholar
  5. 5.
    Wang B, Guss AD, Ghalayon O, et al. Deep transverse metatarsal ligament and static stability of lesser metatarsophalangeal joints. Foot Ankle Int. 2015;36:573–8.CrossRefGoogle Scholar
  6. 6.
    Christensen JC, Jennings MM. Normal and abnormal function of the first ray. Clin Podiatr Med Surg. 2009;26:355–71.CrossRefGoogle Scholar
  7. 7.
    Klein EE, Weil L Jr, Weil LS Sr, Knight J. The underlying osseous deformity in plantar plate tears: a radiographic analysis. Foot Ankle Spec. 2013;6:108–18.CrossRefGoogle Scholar
  8. 8.
    Coughlin MJ, Schutt SA, Hirose CB, et al. Metatarsophalangeal joint pathology in crossover second toe deformity. A cadaveric study. Foot Ankle. 2012;33:133–40.CrossRefGoogle Scholar
  9. 9.
    Deland JT, Lee KT, Sobel M, DiCarlo EF. Anatomy of the plantar plate and its attachments in the lesser metatarsophalangeal joint. Foot Ankle Int. 1995;16:480–6.CrossRefGoogle Scholar
  10. 10.
    Thompson FM, Hamilton WG. Problems of the second metatarsophalangeal joint. Orthopedics. 1987;10:83–9.Google Scholar
  11. 11.
    Kaz AJ, Coughlin M. Crossover second toe: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2007;28:1223–37.PubMedGoogle Scholar
  12. 12.
    Blitz NM, Ford LA, Christensen JC. Second metatarsophalangeal joint arthrography: a cadaveric correlation study. J Foot Ankle Surg. 2004;43:231–40.CrossRefGoogle Scholar
  13. 13.
    Gregg J, Silberstein M, Schneider T, Marks P. Sonographic and MRI evaluation of the plantar plate: a prospective study. Eur Radiol. 2006;16:2661–9.CrossRefGoogle Scholar
  14. 14.
    Klein EE, Weil L Jr, Weil LS Sr, Knight J. Magnetic resonance imaging versus musculoskeletal ultrasound for identification and localization of plantar plate tears. Foot Ankle Spec. 2012;5:359–65.CrossRefGoogle Scholar
  15. 15.
    Klein EE, Weil L Jr, Weil LS Sr, Knight J. Musculoskeletal ultrasound for preoperative imaging of the plantar plate: a prospective analysis. Foot Ankle Spec. 2013;6:196–200.CrossRefGoogle Scholar
  16. 16.
    Feuerstein CA, Weil L Jr, Weil LS Sr, et al. Static versus dynamic musculoskeletal ultrasound for detection of plantar plate pathology. Foot Ankle Spec. 2014;7:259–65.CrossRefGoogle Scholar
  17. 17.
    Mazzuca JW, Yonke B, Downes JM, Miner M. Fluoroscopic arthrography versus MR arthrography of the lesser metatarsophalangeal joints for the detection of tears of the plantar plate and joint capsule: a prospective comparative study. Foot Ankle Int. 2013;34:200–9.CrossRefGoogle Scholar
  18. 18.
    Blitz NM, Ford LA, Christensen JC. Plantar plate repair of the second metatarsophalangeal joint: technique and tips. J Foot Ankle Surg. 2004;43:266–70.CrossRefGoogle Scholar
  19. 19.
    Ford LA, Collins KB, Christensen JC. Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate. J Foot Ankle Surg. 1998;37:217–22.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Eric G. Powell
    • 1
  • Melinda A. Bowlby
    • 1
  • Jeffrey C. Christensen
    • 1
  1. 1.Podiatric Section: Department of Orthopedics, Swedish Medical CenterSeattleUSA

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