Foot & Ankle Surgery located in Fort Worth and Weatherford, TX
Abnormal foot mechanics (i.e. Bunion, Hammertoe, Flatfoot, Equinus, Elongated Second Toe, Shortened First Toe) predispose the second MTPJ to taken an excessive amount of weight. This joint is not designed to withstand this much repetitive weight during ambulation and causes a structural unstable joint complex and eventually a tear.
In advanced/severe stages, the supportive ligaments continue to weaken leading to complete failure of the joint to stabilize the toe and eventually causing the second toe to cross over the big toe. Overuse or injury can cause this to progress even quicker if untreated.
Subluxation/Plantar Plate Tears can vary from an apparent deformity to a subtle change in the toe alignment. The surgeon will assess the reproducibility of your symptoms by moving/manipulating your forefoot as well as gently press on areas to determine any discomfort. A diagnostic injection with local anesthetic may pinpoint the problem.
X-rays are usually ordered to determine the degree of the deformity and assess changes that have occurred.
An MRI may be ordered to determine the extent of the pathology to the plantar plate tear as well as determine surgical planning should surgery be warranted. An Ultrasound may also be utilized to determine the plantar plate structure.
An accurate diagnosis is imperative as symptoms of the subluxation/plantar plate rupture can be similar to a neuroma which is typically treated differently.
Treatment approaches for second MTPJ subluxation/plantar plate ruptures are based on how long the pathology has been present and the severity of the symptoms. The earlier the treatment the better the outcome. Conservative treatment options are aimed at easing the pain of the deformity, stabilizing the joint, and addressing the underlying cause, but again this condition is progressive if intervention does not occur.
Due to the progressiveness of the deformity once the second toe starts to drift or crosses over the big toe it will not return to its normal anatomical position unless surgery is performed. If nonsurgical treatments fail to relieve the subluxation/plantar plate rupture pain and when the pain interferes with daily activities, surgery may be necessary. Your surgeon will select the best procedure to remove deformity and relive the pain. Together with your surgeon consideration will be taken in regards to the extent of your deformity, imaging, your age, and your activity level. The recovery period will vary, depending on the procedure or other procedures performed.
Surgery is typically an outpatient procedure (day surgery) and scheduled at your convenience.
A splint or boot will be placed on your surgical foot/ankle after surgery. No weight to the surgical foot/ankle is advised until your surgeon encourages weight bearing.