Subscribe to RSS
DOI: 10.1055/s-0036-1581115
Imaging of Lesser Metatarsophalangeal Joint Plantar Plate Degeneration, Tear, and Repair
Publication History
Publication Date:
23 June 2016 (online)
![](https://www.thieme-connect.de/media/smr/201602/lookinside/thumbnails/10-1055-s-0036-1581115_00883-1.jpg)
Abstract
Plantar plate degeneration and tear is a common cause of forefoot pain, typically involving the second metatarsophalangeal joint at the proximal phalangeal insertion laterally, frequently confused with the second web space Morton neuroma. The condition has received increased attention with the development of surgical techniques that can result in successful repair of the plantar plate and substantial improvement in patient symptoms. High-resolution MRI or ultrasound can confirm a diagnosis of plantar plate degeneration and tear and exclude other pathologies, particularly Morton neuroma. The normal plantar plate is a mildly hyperechoic structure on ultrasound and is hypointense on all conventional MR sequences. Plantar plate degeneration manifests on ultrasound as hypoechoic echotextural change and on MRI as mild signal hyperintensity on short TE sequences, becoming less conspicuous on long TE sequences. Adjacent entheseal bony irregularity is commonly present. Plantar plate tears on ultrasound may be seen as an anechoic cleft defect or area of heterogeneous echotexture, sometimes more conspicuous with dorsiflexion stress. Plantar plate tears demonstrate greater signal hyperintensity on proton-density sequences, becoming more conspicuous on fat-suppressed proton density and T2-weighted sequences. Edema and fibrotic change in the pericapsular fat plane is commonly seen in the setting of an adjacent plantar plate tear and should not be misinterpreted as reflecting a Morton neuroma.
-
References
- 1 Doty JF, Coughlin MJ. Metatarsophalangeal joint instability of the lesser toes and plantar plate deficiency. J Am Acad Orthop Surg 2014; 22 (4) 235-245
- 2 Coughlin MJ. Second metatarsophalangeal joint instability in the athlete. Foot Ankle 1993; 14 (6) 309-319
- 3 Smith RW, Reischl SF. Metatarsophalangeal joint synovitis in athletes. Clin Sports Med 1988; 7 (1) 75-88
- 4 Deland JT, Lee KT, Sobel M, DiCarlo EF. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int 1995; 16 (8) 480-486
- 5 Johnston III RB, Smith J, Daniels T. The plantar plate of the lesser toes: an anatomical study in human cadavers. Foot Ankle Int 1994; 15 (5) 276-282
- 6 Umans H, Srinivasan R, Elsinger E, Wilde GE. MRI of lesser metatarsophalangeal joint plantar plate tears and associated adjacent interspace lesions. Skeletal Radiol 2014; 43 (10) 1361-1368
- 7 Fernandes EdeA, Mann TS, Puchnick A , et al. Can ultrasound of plantar plate have normal appearance with a positive drawer test?. Eur J Radiol 2015; 84 (3) 443-449
- 8 Deland JT, Sung IH. The medial crossover toe: a cadaveric dissection. Foot Ankle Int 2000; 21 (5) 375-378
- 9 Coughlin MJ, Schutt SA, Hirose CB , et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int 2012; 33 (2) 133-140
- 10 Gregg JM, Silberstein M, Schneider T, Kerr JB, Marks P. Sonography of plantar plates in cadavers: correlation with MRI and histology. AJR Am J Roentgenol 2006; 186 (4) 948-955
- 11 Yao L, Do HM, Cracchiolo A, Farahani K. Plantar plate of the foot: findings on conventional arthrography and MR imaging. AJR Am J Roentgenol 1994; 163 (3) 641-644
- 12 Powless SH, Elze ME. Metatarsophalangeal joint capsule tears: an analysis by arthrography, a new classification system and surgical management. J Foot Ankle Surg 2001; 40 (6) 374-389
- 13 Thompson FM, Hamilton WG. Problems of the second metatarsophalangeal joint. Orthopedics 1987; 10 (1) 83-89
- 14 Gregg JM, Schneider T, Marks P. MR imaging and ultrasound of metatarsalgia—the lesser metatarsals. Radiol Clin North Am 2008; 46 (6) 1061-1078 , vi–vii
- 15 Gregg J, Silberstein M, Schneider T, Marks P. Sonographic and MRI evaluation of the plantar plate: A prospective study. Eur Radiol 2006; 16 (12) 2661-2669
- 16 Klein EE, Weil Jr L, Weil Sr LS, Knight J. Musculoskeletal ultrasound for preoperative imaging of the plantar plate: a prospective analysis. Foot Ankle Spec 2013; 6 (3) 196-200
- 17 Linklater JM. Imaging of sports injuries in the foot. AJR Am J Roentgenol 2012; 199 (3) 500-508
- 18 Barrie J, Khan S, Enion D, Dodds N. Imaging plantar plate tears in lesser metatarsophalangeal joints: MRI versus ultrasound arthrography. Bone Joint Surg Br 2011; 93-B (Suppl IV): 483
- 19 Hayter CL, Linklater JM, Man KH. State of the art MR imaging techniques for the foot and ankle. Curr Radiol Rep 2014; 2: 42
- 20 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) 1079-1081
- 21 Mohana-Borges AV, Theumann NH, Pfirrmann CW, Chung CB, Resnick DL, Trudell DJ. Lesser metatarsophalangeal joints: standard MR imaging, MR arthrography, and MR bursography—initial results in 48 cadaveric joints. Radiology 2003; 227 (1) 175-182
- 22 Lepage-Saucier M, Linda DD, Chang EY , et al. MRI of the metatarsophalangeal joints: improved assessment with toe traction and MR arthrography. AJR Am J Roentgenol 2013; 200 (4) 868-871
- 23 Coughlin MJ, Baumfeld DS, Nery C. Second MTP joint instability: grading of the deformity and description of surgical repair of capsular insufficiency. Phys Sportsmed 2011; 39 (3) 132-141
- 24 Linklater JM, Fessa CK. Imaging findings in arthrofibrosis of the ankle and foot. Semin Musculoskelet Radiol 2012; 16 (3) 185-191