Nery Caio, Coughlin Michael J, Baumfeld Daniel, Raduan Fernando C, Mann Tania Szejnfeld, Catena Fernanda
Foot and Ankle Clinic, UNIFESP-Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
St Alphonsus Foot and Ankle Clinic, Boise, ID, USA.
Foot Ankle Int. 2014 Sep;35(9):876-85. doi: 10.1177/1071100714539659. Epub 2014 Jun 23.
Instability of the lesser metatarsophalangeal (MTP) joints is a common cause of deformity and pain. The purpose of this study was to prospectively evaluate the surgical outcomes for the different grades of plantar plate tears and propose a treatment protocol.
Sixty-eight patients (100 MTP joints) were prospectively enrolled and graded according to the anatomical grade system for plantar plate tears. Based on this classification, the appropriate surgical procedure was chosen as follows: grades 0 and I, thermal shrinkage with radiofrequency; grades II and III, direct reinsertion of the plantar plate; and grade IV, flexor-to-extensor tendon transfer. All surgical procedures were associated with a Weil metatarsal osteotomy. Evaluations were performed before and after surgical treatment with a mean follow-up of 2 years (12-36 months), using clinical and radiological parameters: American Orthopaedic Foot and Ankle Society (AOFAS) Lesser MTP-IF Scale, visual analog scale (VAS), ground touch, joint stability, and toe purchase.
The analysis of the clinical parameters demonstrated a significant improvement of all groups (P < .0001) after surgical treatment, but grade IV had less VAS improvement and a fair AOFAS average score (72 points). All groups improved regarding physical examination parameters, but grade I, III, and IV tears had proportionally less stable MTP joints following surgery, as well as a lower proportion of normal postoperative toe purchase and ground touch. All groups showed a significant improvement regarding radiographic parameters.
All groups of operatively treated patients had significant improvement with regard to subjective and objective parameters. Grades I, III, and IV presented inferior results compared with grades 0 and II.
Level IV, case series.
小趾跖趾关节（MTP）不稳定是畸形和疼痛的常见原因。本研究的目的是前瞻性评估不同等级足底板撕裂的手术效果，并提出一种治疗方案。
前瞻性纳入68例患者（100个MTP关节），并根据足底板撕裂的解剖学分级系统进行分级。基于该分类，选择如下合适的手术方法：0级和I级，射频热缩术；II级和III级，足底板直接重新植入；IV级，屈肌腱转位至伸肌腱。所有手术均联合Weil跖骨截骨术。采用临床和影像学参数，在手术治疗前后进行评估，平均随访2年（12 - 36个月），这些参数包括：美国矫形足踝协会（AOFAS）小趾MTP - IF量表、视觉模拟量表（VAS）、触地情况、关节稳定性和足趾抓地力。
临床参数分析显示，手术治疗后所有组均有显著改善（P <.0001），但IV级VAS改善较少，AOFAS平均评分为中等（72分）。所有组在体格检查参数方面均有改善，但I级、III级和IV级撕裂术后MTP关节稳定性成比例降低，术后足趾抓地力和触地正常的比例也较低。所有组在影像学参数方面均有显著改善。
所有接受手术治疗的组在主观和客观参数方面均有显著改善。与0级和II级相比，I级、III级和IV级的结果较差。
IV级，病例系列。
