Plantar plate tear
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Plantar plate tears are disruptions of the metatarsophalangeal joint (MTPJ) plantar plate(s). They are essentially a form of metatarsophalangeal joint capsular tear, and most frequently occur at the distal lateral aspect of the plantar plate.
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Plantar plate tears can be broadly divided into involving the hallux/great toe/first toe and termed turf toe or sand toe, or the lesser metatarsals/toes 2-5, and termed plantar plate tears 1,7.
Presentation can be acute or chronic and can be associated with other joint conditions such as rheumatoid arthritis. Patients may present with metatarsalgia and/or deformity in cases of full-thickness plantar plate tears.
In the lesser metatarsals, increased weight-bearing load and hyper-extension forces placed on the MTPJs by high-heeled, pointed shoes are thought to be possible predisposing factors.
- dynamic maneuvers with ultrasound can demonstrate discontinuity of the normal plantar plate
- partial-thickness tear:
- following acute trauma, focal edema in an aspect of a plantar plate suggests low-grade sprain or tear, without discontinuity 7
- full-thickness tear:
- proximal retraction
- persistent hyper-extension of the proximal phalanx 1, or valgus/varus deviation of the toe
- indirect features of a plantar plate injury
- metatarsophalangeal joint synovitis
- flexor tendon sheath tenosynovitis
- pseudoneuroma sign 8
- plantar plate - proximal phalanx distance >2.75 mm 8
Clinical differential considerations include
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- 2. Gregg J, Silberstein M, Schneider T, Kerr J, Marks P. Sonography of Plantar Plates in Cadavers: Correlation with MRI and Histology. AJR Am J Roentgenol. 2006;186(4):948-55. doi:10.2214/AJR.04.1481 - Pubmed
- 3. Yao L, Cracchiolo A, Farahani K, Seeger L. Magnetic Resonance Imaging of Plantar Plate Rupture. Foot Ankle Int. 1996;17(1):33-6. doi:10.1177/107110079601700107 - Pubmed
- 4. Umans H & Elsinger E. The Plantar Plate of the Lesser Metatarsophalangeal Joints: Potential for Injury and Role of MR Imaging. Magn Reson Imaging Clin N Am. 2001;9(3):659-69, xii. - Pubmed
- 5. Gregg J, Silberstein M, Schneider T, Marks P. Sonographic and MRI Evaluation of the Plantar Plate: A Prospective Study. Eur Radiol. 2006;16(12):2661-9. doi:10.1007/s00330-006-0345-8 - Pubmed
- 6. Kier R, Abrahamian H, Caminear D et al. MR Arthrography of the Second and Third Metatarsophalangeal Joints for the Detection of Tears of the Plantar Plate and Joint Capsule. AJR Am J Roentgenol. 2010;194(4):1079-81. doi:10.2214/AJR.09.3393 - Pubmed
- 7. Palmer W, Bancroft L, Bonar F et al. Glossary of Terms for Musculoskeletal Radiology. Skeletal Radiol. 2020;49(Suppl 1):1-33. doi:10.1007/s00256-020-03465-1 - Pubmed
- 8. Yamada A, Crema M, Nery C et al. Second and Third Metatarsophalangeal Plantar Plate Tears: Diagnostic Performance of Direct and Indirect MRI Features Using Surgical Findings as the Reference Standard. AJR Am J Roentgenol. 2017;209(2):W100-8. doi:10.2214/ajr.16.17276 - Pubmed