The attachment of the plantar aponeurosis to the proximal phalanx of the toe, through the plantar plate (PP), forms the main flexor of the toe during gait by the reversed windlass mechanism. Disruption of the plantar plate is a common cause of pain, instability and toe deformity. Surgical techniques have recently been described to repair tears but long term results are awaited. This study aims to review the results of a technique designed to reconstruct and reinforce the failed plantar plate and restore the reversed windlass. Through a dorsal extra-articular approach the EDL tendon of the affected toe is used to restore the mechanical link between the proximal phalanx and the plantar aponeurosis on the plantar aspect of the joint. 42 PP reconstructions in 39 patients (36 female) aged 44–72 were undertaken, most frequently on the 2nd toe. 25 required correction of hallux valgus and four had undergone this previously. Follow up was 2–81 months.Introduction
Methods
Excision of prominent metatarsal heads for severe rheumatoid forefoot deformity is well established in clinical practice but results may deteriorate with time. The Stainsby forefoot arthroplasty however, recognises the pathological anatomy of the deformity and is designed to preserve the metatarsal heads by repositioning the plantar plates and forefoot fat pad underneath them. A prospective case series observing the clinical outcomes and changes in pedobarograph patterns in rheumatoid arthritis patients with severe deformity undergoing Stainsby forefoot arthroplasty.Introduction
Design
