Predislocation Syndrome Flashcards
Where is the plantar plate attached to?
firmly attached to base of proximal phalanx
loosely attached to head of metatarsal
what is turf toe?
hyperextension of 1st MPJ
what is sand toe?
hyperflexion of 1st MPJ
describe the relationship of the lumbricals and interossei to the deep transverse metatarsal ligament.
interossei- lie above
lumbricals- lie below
what PE finding is positive in predislocation syndrome?
vertical stress test (Lachman/drawer test)
what is the staging system for predislocation syndrome?
Yu and Judge
What is Yu and Judge stage 1?
mild plantar/dorsal edema
extreme tenderness with palpation
no clinical malalignment
What is Yu and Judge stage 2?
moderate edema
toe doesn’t purchase ground in stance
deviation of toe both clinically and radiographically
What is Yu and Judge stage 3?
moderate edema; extends into toe
more pronounced deviation with possible dorsal dislocation
can proceed to crossover 2nd toe
what additional imaging can you do if MRI/CT isn’t available?
arthrogram
what stage of predislocation is it if a toe doesn’t purchase the ground during stance?
stage 2
What structures attach to the plantar plate?
plantar fascia collateral ligaments of MPJ transverse metatarsal ligament interossei flexor tendons
Why is there a reported healing problem after plantar plate tears?
type 1 collagen is most abundant in the plantar plate (75%) and the next most common is type 2 collagen (21%). this collagenous composition may be a factor that affects poor healing capability of plantar plate. The same healing problem is reported to occur in the meniscus of the knee where there is also a high level of type 1 collagen.
What are some DDx for pain localized to the 2nd MTPJ?
capsulitis
Freiberg infarction
metatarsal stress fx
neuroma
conservative treatment options?
NSAIDs or steroidals (prednisone taper) Figure 8 taping Budin splint orthotics: metatarsal pad shoe modifications- extra wide CAM boot steroidal injections *may cause rupture of PP
How can you use a flexor tendon transfer to your advantage to correct a transverse plane deformity?
the contracture structures on the side of the MTPJ to which the toe is deviated are released through a dorsal incision. Harvest the FDL tendon and split it longitudinally, wrapping each end of the tendon dorsally around the medial or lateral sides of the proximal phalanx.
What distal metatarsal osteotomy can be performed to correct transverse plane deformity?
Weil osteotomy - allows shortening of teh metatarsal, decompression of the MTPJ, and translocation of the capital fragment in the transverse plane and sutured to the extensor hood.
what is the recommended amount of translocation of the met head?
no more than 1/3 to 1/2 the met head width
The FDL transfer (flexor-to-extensor transfer) corrective procedure for transverse plane digital deformity is aka?
Girdlestone-Taylor
if the 2nd toe is deviating medially, which collateral would you cut to correct the transverse plane deformity?
medial collateral ligament
the medial collaterals are tight; lateral collaterals are stretched
why is a dorsal-medial dislocation following failure of plantar plate seen more commonly?
(think about the anatomy!) the second toe is anatomically unique, having insertions of 2 dorsal interosseous tendons but no plantar interosseous tendon. The lumbrical tendon has a medial insertion and provides a slight medial pull in the 2nd toe. Both lumbricals and interossei provide most of the flexion that occurs at the lesser MPJs under normal circumstances, but with dorsal subluxation, they migrate dorsal to the axis of the MPJ and subsequently lose their mechanical ability to provide flexion of the joint.
