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Michael J Coughli - One of the best experts on this subject based on the ideXlab platform.

  • Metatarsophalangeal Joint instability of the lesser toes and plantar plate deficiency
    Journal of The American Academy of Orthopaedic Surgeons, 2014
    Co-Authors: Jesse F Doty, Michael J Coughli
    Abstract:

    Our understanding of lesser toe Metatarsophalangeal Joint instability has increased substantially over the past few decades. Some recent articles on the subject have provided detailed anatomic descriptions that help to characterize the primary stabilizing structures of the Joint. Some surgeons now advocate the incorporation of a primary repair of the plantar plate into the surgical plan for correction of Metatarsophalangeal Joint deviation in the sagittal and transverse planes. New surgical techniques have been developed to expose, inspect, and reliably repair the plantar plate, if necessary. Dorsal and plantar approaches have both been used successfully to repair the plantar plate. Tears of the plantar plate can be repaired primarily or advanced on the base of the proximal phalanx through bone tunnels. Outcomes of these procedures are promising, with improvements in pain and function reported along with sustained deformity correction.

Jesse F Doty - One of the best experts on this subject based on the ideXlab platform.

  • Metatarsophalangeal Joint instability of the lesser toes and plantar plate deficiency
    Journal of The American Academy of Orthopaedic Surgeons, 2014
    Co-Authors: Jesse F Doty, Michael J Coughli
    Abstract:

    Our understanding of lesser toe Metatarsophalangeal Joint instability has increased substantially over the past few decades. Some recent articles on the subject have provided detailed anatomic descriptions that help to characterize the primary stabilizing structures of the Joint. Some surgeons now advocate the incorporation of a primary repair of the plantar plate into the surgical plan for correction of Metatarsophalangeal Joint deviation in the sagittal and transverse planes. New surgical techniques have been developed to expose, inspect, and reliably repair the plantar plate, if necessary. Dorsal and plantar approaches have both been used successfully to repair the plantar plate. Tears of the plantar plate can be repaired primarily or advanced on the base of the proximal phalanx through bone tunnels. Outcomes of these procedures are promising, with improvements in pain and function reported along with sustained deformity correction.

  • Metatarsophalangeal Joint instability of the lesser toes.
    Journal of Foot & Ankle Surgery, 2013
    Co-Authors: Jesse F Doty, Michael J. Coughlin
    Abstract:

    Metatarsophalangeal Joint instability of the lesser toes is a common finding and a common cause of metatarsalgia. The clinical presentation can include swelling without digital deformity; however, often, this can progress to the development of coronal and transverse plane malalignment. In some cases, frank Metatarsophalangeal Joint dislocation can develop. The treatment regimen has historically focused on indirect surgical realignment using soft tissue release, soft tissue reefing, tendon transfers, and periarticular osteotomies. An improved understanding of the plantar plate has recently led to the development of a clinical staging system and surgical grading system of plantar plate attenuation. A dorsal surgical approach, using a Weil osteotomy, allows the surgeon to directly access and repair or advance the plantar plate to the base of the proximal phalanx. The addition of direct plantar plate repair could be a significant advancement in the reconstruction and realignment of Metatarsophalangeal Joint instability.

Nicholas A Giovinco - One of the best experts on this subject based on the ideXlab platform.

  • use of Metatarsophalangeal Joint dorsal subluxation in the diagnosis of plantar plate rupture
    Journal of Foot & Ankle Surgery, 2019
    Co-Authors: Mariechristine Ergero, Julie Ferland, Scot D Malay, Sara E Lewis, Jennife A Urkma, Nicholas A Giovinco
    Abstract:

    : A dorsal drawer exam, also known as a modified Lachman's test, is a common clinical test for plantar plate insufficiency. This disorder presents as a dislocated Metatarsophalangeal Joint. The aim of this cadaveric case study was to quantify the degree of the plantar plate pathology necessary to correlate with a positive Lachman's test. The second Metatarsophalangeal Joint was tested on 18 cadaveric lower extremities. Limbs with previous digital surgery or with an obvious digital deformity were excluded from this study. A plantar linear incision over the plantar aspect of the second Metatarsophalangeal Joint was performed, and the flexor tendons were retracted to expose the plantar plate. After evaluating the plantar plate's integrity and measuring its width, a Lachman's test was then performed under fluoroscopy. The plantar plate was subsequently severed in a serial manner in 2-mm increments. A modified Lachman's test was performed with the different levels of rupture to assess the degree of dislocation. We found that a tear as small as 2 mm, detected in 12 (66.7%) of 18 specimens, produced gross instability in the second Metatarsophalangeal Joint. We also showed that a simulated plantar plate tear ≥4 mm but <6 mm resulted in Joint subluxation (positive modified Lachman's test) with a sensitivity of 90.3%. This study reinforces the finding that a modified Lachman's test is a clinical exam that demonstrates high sensitivity in diagnosing plantar plate insufficiency.

  • Use of Metatarsophalangeal Joint Dorsal Subluxation in the Diagnosis of Plantar Plate Rupture.
    Journal of Foot & Ankle Surgery, 2018
    Co-Authors: Marie-christine Bergeron, Julie Ferland, Sara E Lewis, D. Scot Malay, Jennifer A. Burkmar, Nicholas A Giovinco
    Abstract:

    : A dorsal drawer exam, also known as a modified Lachman's test, is a common clinical test for plantar plate insufficiency. This disorder presents as a dislocated Metatarsophalangeal Joint. The aim of this cadaveric case study was to quantify the degree of the plantar plate pathology necessary to correlate with a positive Lachman's test. The second Metatarsophalangeal Joint was tested on 18 cadaveric lower extremities. Limbs with previous digital surgery or with an obvious digital deformity were excluded from this study. A plantar linear incision over the plantar aspect of the second Metatarsophalangeal Joint was performed, and the flexor tendons were retracted to expose the plantar plate. After evaluating the plantar plate's integrity and measuring its width, a Lachman's test was then performed under fluoroscopy. The plantar plate was subsequently severed in a serial manner in 2-mm increments. A modified Lachman's test was performed with the different levels of rupture to assess the degree of dislocation. We found that a tear as small as 2 mm, detected in 12 (66.7%) of 18 specimens, produced gross instability in the second Metatarsophalangeal Joint. We also showed that a simulated plantar plate tear ≥4 mm but

Michael J. Coughlin - One of the best experts on this subject based on the ideXlab platform.

  • Arthrodesis of the First Metatarsophalangeal Joint with Vitallium Plate Fixation
    Foot & Ankle International, 2016
    Co-Authors: Michael J. Coughlin, Richard V. Abdo
    Abstract:

    Forty-seven patients (58 feet) underwent first Metatarsophalangeal Joint fusion with a small Vitallium plate (Howmedica, Inc., Rutherford, NJ). Congruous Joint surfaces were prepared with either cone-shaped or cup-shaped reamers. At an average follow-up of 19.2 months, 98% (57 feet) were successfully fused. Ninety-three percent (54 feet) noted good or excellent results. Plate removal was necessary in only 7% (4 feet) of cases. Complications included nonunion with plate breakage in 2% (1 foot) and delayed union in 2% (1 foot) of cases. This technique was useful and predictable in achieving successful fusion of the first Metatarsophalangeal Joint.

  • Metatarsophalangeal Joint instability of the lesser toes.
    Journal of Foot & Ankle Surgery, 2013
    Co-Authors: Jesse F Doty, Michael J. Coughlin
    Abstract:

    Metatarsophalangeal Joint instability of the lesser toes is a common finding and a common cause of metatarsalgia. The clinical presentation can include swelling without digital deformity; however, often, this can progress to the development of coronal and transverse plane malalignment. In some cases, frank Metatarsophalangeal Joint dislocation can develop. The treatment regimen has historically focused on indirect surgical realignment using soft tissue release, soft tissue reefing, tendon transfers, and periarticular osteotomies. An improved understanding of the plantar plate has recently led to the development of a clinical staging system and surgical grading system of plantar plate attenuation. A dorsal surgical approach, using a Weil osteotomy, allows the surgeon to directly access and repair or advance the plantar plate to the base of the proximal phalanx. The addition of direct plantar plate repair could be a significant advancement in the reconstruction and realignment of Metatarsophalangeal Joint instability.

  • Second Metatarsophalangeal Joint instability in the athlete.
    Foot & Ankle International, 1993
    Co-Authors: Michael J. Coughlin
    Abstract:

    In a group of athletically active patients, second Metatarsophalangeal Joint Instability was diagnosed in nine patients (11 toes). A positive drawer sign was pathognomonic of early second metatarso...

Brian R Umberger - One of the best experts on this subject based on the ideXlab platform.

  • relationship between clinical measurements and motion of the first Metatarsophalangeal Joint during gait
    Journal of Bone and Joint Surgery American Volume, 1999
    Co-Authors: Deborah A Nawoczenski, Judith F. Baumhauer, Brian R Umberger
    Abstract:

    Background: The range of Joint motion is a commonly reported outcome measure in assessment of the great toe. Although motion of the first Metatarsophalangeal Joint during gait is of primary functional importance, clinicians rely on relatively static clinical measures to assess this Joint. The relationship between the results of commonly used clinical tests of motion of the first Metatarsophalangeal Joint and motion of this Joint during gait was assessed in a study of thirty-three subjects who had no history of a pathological condition of the foot or ankle. Methods: An electromagnetic tracking device was used to acquire three-dimensional orientation data on the hallux with respect to the first metatarsal. Receivers were secured to the skin overlying the proximal phalanx of the hallux, the first metatarsal, and the medial aspect of the calcaneus. Measurements were recorded during four clinical tests. These tests assessed the active range of motion of the first Metatarsophalangeal Joint with the subject weight-bearing, the passive range of motion with the subject weight-bearing, the passive range of motion with the subject non-weight-bearing, and the motion during a heel-rise. The data collected with these tests were compared with motion of the first Metatarsophalangeal Joint during walking. The focus of the analysis was the dorsiflexion component of rotation. Results: With the exception of the passive range of motion with the subject weight-bearing, the ranges of motion measured during all of the clinical tests exceeded the motion of the first metatarsal Joint that is required during normal walking. The motion measured during heel-rise (r = 0.87, p < 0.001) and the active range of motion with the subject weight-bearing (r = 0.80, p < 0.001) had the strongest correlations with motion of the first Metatarsophalangeal Joint during gait. The mean dorsiflexion during the test of the active range of motion (44 degrees) was closer to the mean dorsiflexion during gait (42 degrees) than was the mean value measured during the heel-rise test (58 degrees). This study also demonstrated that the clinical tests are not interchangeable as their mean results differed by as much as 21 degrees. Conclusions: The selection of a reliable and valid clinical test and an understanding of the relationship of the results of this test to the motion requirements during normal gait will help to standardize reporting techniques and will improve the ability of the clinician to determine the outcomes of treatment. This study showed that measurement of the active range of motion with the subject weight-bearing was a reliable and valid test and that the results were strongly correlated with motion of the first Metatarsophalangeal Joint during gait.