What is the predislocation syndrome?
R. Pascual et al. (1) defined the predislocation syndrome as: “an either an acute, subacute, or chronic inflammatory process involving the lesser metatarsophalangeal joints“. It is a common cause of metatarsalgia that is frequently unrecognized or misdiagnosed.
What are the signs of the predislocation syndrome?
Synovitis and joint effusion may be seen early on with progression of instability to encompass predislocation and eventual complete dislocation of the MTP joint.
What may it happen if the predislocation syndrome is not treated?
If this condition is not treated, it may lead to a plantar plate and capsular attenuation and metatarsophalangeal joint instability. Likewise, the predislocation syndrome is very debilitating for the patients, limiting their activity and recreation.
The disorder results from a failure of the plantar plate and collateral ligaments which stabilize the metatarsophalangeal joints and is typically associated with abnormal forefoot loading patterns.
What are the treatments avalaible for the predislocation syndrome?:
Treatment protocols for second MTPJ problems are aimed to relieve patient´s symptoms. Conservative treatment and offloading devices have dominated the treatment options for the practitioner.
Conservative treatments:
I could help you to have your pain eased by prescribing and fitting different treatments and devices for your feet, such as:
- New Fixtoe device
Indicated for digit problems and forefoot pathologies (claw and hammer toes, plantar keratosis, etc). Contraindicated in diabetic people; presence of oedema or swelling in the foot; open wounds or ulcers; rigid toe deformities; skin problems. Taping
Footwear alterations
Are the corticosteroids injections recommended as a good treatment for the predislocation syndrome?
Corticosteroids inhibit collagen synthesis, and the ligaments are made up of 80-85% collagen type I; It has been proved that corticosteroid injection not only can accelerate the evolution of the deformity quickly, but also can delay the healing of the stabilizer structures.
Are there any surgical procedures to repair the plantar plate damage?
Surgical techniques and procedures have been developed for the past years to correct the mechanical and structural defects that can affect this joint.
What about the plantar plate reparation?
Although surgical repair of the plantar plate has improved, there has been no consensus yet on the clinical advantage of any single technique, or combination of techniques, described in the literature. Because of the complexity and variability of digital and MTPJ deformities, there are many procedures, and no any procedure has become the gold standard.
Would you like to try any of the conservative methods to relief the pain on the ball of your foot?
Book your assessment now. I am looking forward to listening your story and helping you
Let´s make your feet resilient
Ivan Maestre. Podiatrist. Resilient Foot
References:
PubMed
1:Gutiérrez, R. & Rodríguez, M. & Villaescusa, P. & Ros, P. & García-Campos, Jonatan. (2010). Criterios de selección de tratamiento en el síndrome de predislocación. Journal of School Psychology – J SCH PSYCHOL. 44. 364-370. 10.1016/j.rh.2010.07.004.
2:Yu GV, Judge MS, Hudson JR, Seidelmann FE. Predislocation syndrome.
Progressive subluxation/dislocation of the lesser metatarsophalangeal joint. J Am Podiatr Med Assoc. 2002 Apr;92(4):182-99
3: Mendicino RW, Statler TK, Saltrick KR, Catanzariti AR. Predislocation
syndrome: a review and retrospective analysis of eight patients. J Foot Ankle
Surg. 2001 Jul-Aug;40(4):214-24
4: Prissel MA, Hyer CF, Donovan JK, Quisno AL. Plantar Plate Repair Using a
Direct Plantar Approach: An Outcomes Analysis. J Foot Ankle Surg. 2017 May-
Jun;56(3):434-439
5: Hollawell SM, Kane BJ, Paternina JP, Santamaria GJ, Heisey CM. Lesser
Metatarsophalangeal Joint Pathology Addressed With Arthrodesis: A Case Series. J
Foot Ankle Surg. 2019 Mar;58(2):387-391
6: McAlister JE, Hyer CF. The direct plantar plate repair technique. Foot Ankle
Spec. 2013 Dec;6(6):446-51
