title: Prospective evaluation of protocol for surgical treatment of lesser MTP joint plantar plate tears.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level IV, case series.
authors: Foot and Ankle Clinic, UNIFESP-Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil caionerymd@gmail.com.
authors: Caio
authors: C
authors: Nery
authors: St Alphonsus Foot and Ankle Clinic, Boise, ID, USA.
authors: Michael J
authors: MJ
authors: Coughlin
authors: Foot and Ankle Surgeon, Felício Rocho Hospital, Belo Horizonte, MG, Brazil.
authors: Daniel
authors: D
authors: Baumfeld
authors: UNIFESP-Escola Paulista de Medicina, São Paulo, SP, Brazil.
authors: Fernando C
authors: FC
authors: Raduan
authors: UNIFESP-Escola Paulista de Medicina, São Paulo, SP, Brazil.
authors: Tania Szejnfeld
authors: TS
authors: Mann
authors: UNIFESP-Escola Paulista de Medicina, São Paulo, SP, Brazil.
authors: Fernanda
authors: F
authors: Catena
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery; D008683:Metatarsophalangeal Joint / Q000293:injuries* / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D000078702:Radiofrequency Therapy; D013709:Tendon Transfer; D064232:Visual Analog Scale
keywords: MTP plantar plate repair; MTP plantar plate tears; Weil metatarsal osteotomy; lesser toe dislocation; metatarsalgia; metatarsophalangeal joint instability