Plantar Plate Repair

Dislocated metatarsal phalangeal joint
(Plantar plate rupture)

Procedure

Weil lesser metatarsal osteotomy + Ligament repair.

Aims of surgery

Reduces the pressure/pain under the head of the bone/ball of the foot and in the joint – realigns the joint correctly to avoid long-term arthritis and further deformity.

Advantages of this operation

The shortening/reduction of prominence is predictable.
The underlying cause of the pain and deformity is reduced.
Specific risks of this operation
Transfer of corn to adjacent joint 30%.
Feeling of joint stiffness (approximately 2.4%).
Toe does not touch ground (floating toe).
Recurrence.
Scarring.
Non-union of bone (bone does not knit together).
Fixation problems (with the screws/pins).
Pain at the surgical site.
Need for further surgery.
Deep Vein Thrombosis/Pulmonary Embolism.

Operation time

Usually about 45–60 minutes.

Incision placement/stitches

On the top of the foot over the bone to be corrected and with absorbable stitches where possible. Occasionally, if the ligament cannot be repaired dorsally then a second incision is required under the joint to repair the ligament.

Procedure

A controlled fracture is performed to the metatarsal and the bone lifted up. The ligament is identified and repaired through the same incision, or occasionally from under the foot. Sometimes a skin lesion under the ball of the foot is removed at the same time.

Fixation

A wire or screw is used to hold the bone cut together. You will not notice these and they do not usually need to be removed (<20%).

Will I have plaster?

No. You will be provided with a special shoe.

Is this a day procedure?

Yes, you can usually go home the same day.

Estimated time off work

Non-manual work approximately 4–6 weeks.
Manual work 6–8 weeks.

Indications for the procedure

Pain/callous/corn formation beneath the ball of the foot.
Difficulty with shoe fit despite wearing sensible footwear.

Alternative treatments

Manage your symptoms by altering activity levels, using painkillers and anti inflammatories, extra depth/width shoes, rocker sole (stiff curved sole) using an insole or orthotic foot support, joint injection therapy. Regular podiatry care to reduce painful lesions. Steroid injections for painful joints.

More information

Speak with your consultant.

 
 

Weil osteotomy and plantar plate repair for dislocated joints

The operation can be performed comfortably under a local anaesthetic block, which is achieved by either a series of injections around the ankle, or an injection behind your knee. You can be fully awake during the operation and will be able to feel touch, pressure and vibration, but you will not feel any pain. If you do not wish to consider having the operation performed whilst still awake, or your Consultant does not feel this is the best option for you, you will be offered local anaesthetic with sedation or general anaesthesia.

The operation takes about 45–60 minutes although you will be in the day surgery unit for some time before the surgery and afterwards, to allow you an opportunity to rest post-operatively. You must have a competent adult at home for the first day and night after surgery. This allows us to be sure you will be safe for the first night.

 

Post-Operative Care

First 2–4 days after surgery

  • This is the time you are likely to have the most pain, but you will be given painkillers to help. You must rest completely for 2–4 days.

  • You will be able to stand and take weight on your non-operated foot after the operation, but you must rest, with your feet up, as much as possible.

  • You should restrict your walking to going to the bathroom. When getting about, use your shoe in the way you will have been shown.

  • You can get about a little more after 2 days.

1 week after surgery

  • You will need to attend an appointment for your foot to be checked and redressed.

  • You may start to do a little more within pain limits. Pain and swelling means you are doing too much.

2 weeks after surgery

  • Sutures will be removed if necessary.

  • You may be asked to move your toe through a range of motion to maintain mobility.

Between 3–4 weeks after surgery

  • An x-ray will be taken to check bone healing.

  • Once directed by your consultant, you will be able to start wearing a good lace-up shoe/trainer.

  • You will not need a bandage any longer and can get the foot wet.

Between 4–8 weeks after surgery

  • The foot starts to return to normal and you can return to normal shoes (4–8 weeks) (89%).

  • The foot will still be quite swollen especially at the end of the day.

  • You may return to work but may need longer if you have an active job.

  • You may return to driving if you can perform an emergency stop. You must check with your insurance company and Mr. Cichero before driving again.

  • Whilst normal activity will be resumed, sport should be avoided.

Between 8–12 weeks after surgery

  • The foot should continue to improve and begin to feel normal again.

  • There will be less swelling.

  • Sport can be considered after 3 months depending on your recovery.

6 months after surgery

  • You will have a final review between 3–6 months following surgery.

  • The swelling should now be slight and you should be getting the full benefit of the surgery.

12 months after surgery

The foot has stopped improving with all healing complete.

Please note, if a complication arises, recovery may be delayed.