Histological changes of the plantar plate in patients with metatarsalgia
The plantar plate of the lesser toes is wide, strong and flexible fibro-cartilaginous structure of a rectangular or trapezoidal shape, passing from the plantar surface of the metatarsal neck to the base of the proximal phalanx. It is believed that degenerative changes of the plantar plate that occur during longterm cyclic overloads are the main cause of pain and the development of metatarsalgia.
Objective: analysis of the plantar plate histology results in patients with metatarsalgia.
Methods: 16 lesser metatarsophalangeal joint plantar plates of the 9 patients (2 were males, 7 were females with average age of (65.28 ± 10.32) years) with metatarsalgia were obtained for histology assessment (the second metatarsophalangeal joint plantar plates were 12, the third — 4). 8 plantar plate after lesser toe exarticulation, 8 — after resection arthroplasty were obtained. Fragments of plantar plate with proximal phalanx were selected for histology. Paraffin sections were analyzed with bright-field light microscopy (Olympus CX-41). Grades of severity of morphology were evaluated by VAS.
Results: the material in plantar plate biopsies was represented by fragments of pathologically altered connective tissue, changes in the regularity and density of collagen fibers, the appearance of blood vessels, a combination of loose connective tissue and dense connective tissue; subtotal and total fibronecrosis with complete degeneration of the fibrous-cartilage structure of the enthesis.
Conclusions: histological changes of the plantar plate in patients with metatarsalgia are characterized by an irreversible dystrophicdegenerative process in the fibrous-cartilage structure of the enthesis, which morphologically corresponds to non-specific enthesopathy.
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