Plantar Plate Tears: A Review of the Modified Flexor Tendon Transfer Repair for Stabilization  Bob Baravarian, DPM, Jonathan Thompson, DPM, Doron Nazarian, DPM  Clinics in Podiatric Medicine and Surgery  Volume 28, Issue 1, Pages 57-68 (January 2011) DOI: 10.1016/j.cpm.2010.11.002 Copyright © 2011 Terms and Conditions

Fig. 1 Dorsal drawer test of the second MPJ. With dorsal pull of the toe, there is pain in the plantar capsule and laxity of the associated toe is noted. Clinics in Podiatric Medicine and Surgery 2011 28, 57-68DOI: (10.1016/j.cpm.2010.11.002) Copyright © 2011 Terms and Conditions

Fig. 2 Plantar pressure on the MPJ capsule causing pain. Note medial shift of the toe commonly associated with lateral plantar plate and ligament tear. Clinics in Podiatric Medicine and Surgery 2011 28, 57-68DOI: (10.1016/j.cpm.2010.11.002) Copyright © 2011 Terms and Conditions

Fig. 3 MRI of MPJ joint showing tear of the plantar plate off the base of the proximal phalanx. Clinics in Podiatric Medicine and Surgery 2011 28, 57-68DOI: (10.1016/j.cpm.2010.11.002) Copyright © 2011 Terms and Conditions

Fig. 4 Angle for proper Weil osteotomy. Note the need to skive the dorsal articular surface to shorten the metatarsal with minimal plantar flexion. Clinics in Podiatric Medicine and Surgery 2011 28, 57-68DOI: (10.1016/j.cpm.2010.11.002) Copyright © 2011 Terms and Conditions

Fig. 5 Shift of the metatarsal after osteotomy in transverse plane for angular correction of the toe. Clinics in Podiatric Medicine and Surgery 2011 28, 57-68DOI: (10.1016/j.cpm.2010.11.002) Copyright © 2011 Terms and Conditions

Fig. 6 Split flexor tendon transfer performed around the medial and lateral proximal phalanx and tied to the dorsal base of the toe. Note the proximal positioning of the transfer to better support the MPJ. Clinics in Podiatric Medicine and Surgery 2011 28, 57-68DOI: (10.1016/j.cpm.2010.11.002) Copyright © 2011 Terms and Conditions

Fig. 7 Dorsal split flexor tendon transfer with sling tie into the MPJ capsule after capsular reefing for added correction of the medial toe deviation. Clinics in Podiatric Medicine and Surgery 2011 28, 57-68DOI: (10.1016/j.cpm.2010.11.002) Copyright © 2011 Terms and Conditions

Fig. 8 Preoperative picture of plantar plate tear with hallux valgus, elevated second toe, hammertoe deformity, and medial shift of the second toe. Clinics in Podiatric Medicine and Surgery 2011 28, 57-68DOI: (10.1016/j.cpm.2010.11.002) Copyright © 2011 Terms and Conditions

Fig. 9 Postoperative picture of the same patient as in Fig. 8 with osteotomy bunionectomy, hammertoe correction with arthrodesis, flexor tendon transfer, and capsular reefing of the MPJ. Clinics in Podiatric Medicine and Surgery 2011 28, 57-68DOI: (10.1016/j.cpm.2010.11.002) Copyright © 2011 Terms and Conditions