Intermediate Learning Pathway: What’s Up with the Second Ray? Etiology and Various Treatment Options of the Second Met

Learning Objectives of this Pathway:

• Understand the anatomy and etiology of 2nd ray pathology
• Understand the workup and imaging of 2nd ray pathology
• Recognize and understand the different options for repair of plantar plate tears and other MTP joint pathology

Day 1:

JFAS Articles:

• Metatarsophalangeal Joint Instability of the Lesser Toes
• A Systematic Review of Plantar Plate Repair in the Management of Lesser Metatarsophalangeal Joint Instability

Clinical Sessions (full course):
The 2nd Ray: Knowns and Unknowns

Day 2:

JFAS Articles:
Combined Plantar Plate and Hammertoe Repair with Flexor Digitorum Longus Tendon Transfer for Chronic, Severe Sagittal Plane Instability of the Lesser Metatarsophalangeal Joints: Preliminary Observations

Day 3:

JFAS Articles:

• Anatomic Reconstruction Versus Traditional Rebalancing in Lesser Metatarsophalangeal Joint Reconstruction
• Technique Using Interference Fixation Repair for Plantar Plate Ligament Disruption of Lesser Metatarsophalangeal Joints

Podcasts:
Freiberg's Infraction and Second MTP Arthritis - Salvage or Fuse

Clinical Sessions (individual):

• Sub 2nd MPJ Instability: Plantar Plate Repair vs. FDL Transfer - 2nd MPJ Instability - Flexor Plate Repair vs. Flexor Tendon X-fer
• Sub 2nd MPJ Instability: Plantar Plate Repair vs. FDL Transfer - Flexor Tendon Transfer vs Plantar Plate Repair

Additional Outside Journal References:

Lesser Metatarsophalangeal Joint Instability: Advancements in Plantar Plate Reconstruction.
Foot Ankle Clin. 2018 Mar;23(1):127-143. doi: 10.1016/j.fcl.2017.09.009. Epub 2017 Nov 16.

Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability.
Foot Ankle Int. 2017 Mar;38(3):234-242. doi: 10.1177/1071100716679110. Epub 2016 Nov 16

Metatarsophalangeal joint stability: a systematic review on the plantar plate of the lesser toes.
J Foot Ankle Res. 2016 Aug 19;9:32. doi: 10.1186/s13047-016-0165-2. eCollection 2016.

Prospective evaluation of protocol for surgical treatment of lesser MTP joint plantar plate tears.
Foot Ankle Int. 2014 Sep;35(9):876-85. doi: 10.1177/1071100714539659. Epub 2014 Jun 23.

The Role of First Ray Insufficiency in the Development of Metatarsalgia.
Foot Ankle Clin. 2019 Dec;24(4):641-648. doi: 10.1016/j.fcl.2019.07.001. Epub 2019 Sep 5. Review.

Magnetic resonance imaging versus musculoskeletal ultrasound for identification and localization of plantar plate tears.
Foot Ankle Spec. 2012 Dec;5(6):359-65. doi: 10.1177/1938640012463061. Epub 2012 Oct 16.

Foot Ankle Clin. 2018 Mar;23(1):103-126. doi: 10.1016/j.fcl.2017.09.008. Review.

Foot Ankle Int. 2013 Oct;34(10):1436-42. doi: 10.1177/1071100713491728. Epub 2013 Jun 17.

Clin Podiatr Med Surg. 2011 Jan;28(1):57-68. doi: 10.1016/j.cpm.2010.11.002. Review.

Clin Podiatr Med Surg. 2013 Jul;30(3):313-25. doi: 10.1016/j.cpm.2013.04.009. Review.

Foot Ankle Spec. 2019 Jun 11:1938640019846974. doi: 10.1177/1938640019846974. [Epub ahead of print]