Pre-dislocation Options

August 16, 2011
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We’ve discussed pre-dislocation syndrome’s signs and symptoms, as well as conservative treatment available to stop its progression. Even with early recognition and immediate treatment, pre-dislocation syndrome can progress to a chronic issue and require surgical treatment. No one individual surgical option fits every situation, and each case must be examined for the underlying cause to determine which surgical procedure to use. Talk with your doctor to know which surgical option fits your circumstances the best. We’ll discuss two ways to surgically address pre-dislocation syndrome.

One surgical option is to directly go in and repair the plantar plate. Remember, the plantar plate is the thickened portion of the joint capsule on the bottom side of the foot that prevents your toes from dislocating. To repair this, the surgeon would make a cut on the bottom of the foot under the affected toe joint. The surgeon would then proceed to sew the planter plate back together using sutures. The toe will be placed back into its correct position and the plantar plate will be tightened. Sewing the plantar plate back together will allow it to heal quicker and regain its proper strength. Healing time is between 5-6 weeks, but during that time, you can wear a small boot and walk on it. Most patients have little to no downtime or pain.

Another surgical option is to do a flexor tendon transfer. Can you curl your toes up? If so, this procedure will be easy to understand. When you curl your toes, you are flexing them. This happens because the muscles that flex your toes attach to bone on the bottom side of the toes. What if we took that tendon and moved it so it attached to the top side of the toe? When you flex your toes, it would have a greater pull on the top side of the toe to stay down and not dislocate toward the top side of the foot. This would directly fight the problem that pre-dislocation syndrome presents. The only side effect of this procedure would be that you may have some stiffness of that toe. However, most patients have little to no pain. Some studies have even shown that combining a plantar plate repair with a tendon transfer was more effective in the long run than either procedure done alone.

There are many other procedures available, including replacing the joint with an implant, joint fusion, or shortening a metatarsal bone that is too long. These procedures are beyond the scope of this blog, but your podiatric surgeon will know when these more aggressive procedures are needed.

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