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Plantar plate tear

Raymond Y Hsu, Alexej Barg, Florian Nickisch
The plantar plate and associated collateral ligaments are the main stabilizers of each of the lesser metatarsophalangeal joints. Although clinical examination and plain radiographs are usually sufficient to establish the diagnosis of a plantar plate tear, MRI or fluoroscopic arthrograms may help in specific cases. Recent results with a dorsal approach to plantar plate repair are promising with respect to pain relief and patient satisfaction.
March 2018: Foot and Ankle Clinics
Martin Jordan, Manfred Thomas, Wolfgang Fischer
With the current data concentrating on different operative treatment options for plantar plate tears, few data can be found on possible nonoperative treatment strategies for this entity and the specifics of such treatment. In the present case report, the successful nonoperative treatment of a patient with a rupture of the plantar plate in a lesser toe metatarsophalangeal joint is presented. The patient was followed up using repeat clinical examinations and high-resolution magnetic resonance imaging scans for 1 year after the imitation of therapy to provide information on the different stages of the healing process...
July 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
André Fukunishi Yamada, Michel D Crema, Caio Nery, Daniel Baumfeld, Tania Szejnfeld Mann, Abdalla Y Skaf, Artur da Rocha Correa Fernandes
OBJECTIVE: The objective of our study was to assess the diagnostic performance and associations of the direct and indirect MRI features of the metatarsophalangeal (MTP) joint that are thought to be related to tears of the plantar plate (PP) using surgical findings as the reference standard. MATERIALS AND METHODS: We retrospectively included 23 patients with symptomatic instability of lesser MTP joints who had undergone preoperative 1.5-T MRI and surgical assessment...
August 2017: AJR. American Journal of Roentgenology
Phinit Phisitkul, Vinay Hosuru Siddappa, Tinnart Sittapairoj, Jessica E Goetz, Bryan D Den Hartog, John E Femino
BACKGROUND: Access to the plantar plate has been described using either a plantar approach or an extensive dorsal approach that required complete joint destabilization and often a metatarsal osteotomy. Clinical scenarios related to plantar plate tear vary and the pathologies in early stages are frequently limited to unilateral soft tissue structures; a less invasive operative approach may be possible. A novel approach requiring a release of only the lateral collateral ligament and the lateral half of the plantar plate is presented in this cadaver model; the extent of joint exposure possible is described...
July 2017: Foot & Ankle International
Michael Stone, William Eyler, Joshua Rhodenizer, Marnix van Holsbeeck
OBJECTIVES: Sonography is often used in the evaluation of forefoot disorders, and its use has been suggested in the diagnosis of plantar plate tears. This study aimed to assess the accuracy of sonography in the diagnosis of plantar plate tears of the lesser digits using gross dissection as the reference standard. METHODS: The second through fifth digits of 6 cadavers were examined with sonography to evaluate for plantar plate tears. The examination was performed by a single musculoskeletal radiologist in longitudinal and short axes, and plates were graded as torn or intact...
April 11, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Xin Duan, Lang Li, Dai-Qing Wei, Ming Liu, Xi Yu, Zhao Xu, Ye Long, Zhou Xiang
BACKGROUND: Plantar plate tears could be the reason of forefoot pain, affecting foot function. Magnetic resonance imaging (MRI) and ultrasound (US) were commonly used for the diagnosis of plantar plate tears. The decision of whether to use MRI or US carried some controversy. Our study aimed to find out the diagnostic accuracy of MRI versus US for plantar plate tears. METHODS: The database of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and relative orthopedic meetings until May 2016 were searched...
January 21, 2017: Journal of Orthopaedic Surgery and Research
Adam E Fleischer, Erin E Klein, Maheen Ahmad, Shivang Shah, Fernanda Catena, Lowell Scott Weil, Lowell Weil
BACKGROUND: Plantar plate pathology is common, yet it is unclear whether, and to what extent, the length of the second metatarsal contributes to this problem. METHODS: We conducted a retrospective case-control (1:2) study to examine radiographic risk factors for plantar plate tears. One hundred patients (age 55.7 ± 12.3 years) with plantar plate injuries and 200 healthy controls (age 56.3 ± 11.3 years) were included. Cases were defined as patients with nonacute, isolated, plantar plate pathology of the second metatarsophalangeal joint confirmed by intraoperative inspection at a single foot and ankle specialty practice from June 1, 2007, to January 31, 2014...
March 2017: Foot & Ankle International
Wesley W Flint, David M Macias, James R Jastifer, Jesse F Doty, Christopher B Hirose, Michael J Coughlin
BACKGROUND: Lesser metatarsophalangeal (MTP) joint instability is a common cause of forefoot pain. Advances in operative technique and instrumentation have made it possible to anatomically treat plantar plate tears through a dorsal approach. Our goal was to evaluate the subjective, functional, and radiographic outcomes of plantar plate repair (PPR) from a dorsal approach. METHODS: A prospective case series was performed evaluating the results of PPR in 97 feet with 138 plantar plate tears...
March 2017: Foot & Ankle International
Gary M LiMarzi, Kurt F Scherer, Michael L Richardson, David R Warden, Christopher W Wasyliw, Jack A Porrino, Christopher R Pettis, Gideon Lewis, Christopher C Mason, Laura W Bancroft
A variety of surgical procedures exist for repair of both traumatic and degenerative osseous and soft-tissue pathologic conditions involving the foot and ankle. It is necessary for the radiologist to be familiar with these surgical procedures, so as to assess structural integrity, evaluate for complicating features, and avoid diagnostic pitfalls. Adequate interpretation of postoperative changes often requires access to surgical documentation to evaluate not only the surgery itself but the expected timeline for resolution of normal postoperative changes versus progressive disease...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Caio Nery, Hilary Umans, Daniel Baumfeld
The plantar plate has recently gained more attention as an important structure contributing to lesser metatarsophalangeal joint stability. This has prompted a significant growth of interest in the anatomy and biomechanics of the plantar plate and in the diagnosis and treatment of its injuries. Improved understanding of plantar plate function and predictable patterns of degeneration and failure has led to the development of a clinical staging and surgical grading system of plantar plate lesions. Relatively recent innovations allow the surgeon to access and repair plantar plate tears directly with reinsertion onto the base of the proximal phalanx...
April 2016: Seminars in Musculoskeletal Radiology
James M Linklater, Stephen J Bird
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...
April 2016: Seminars in Musculoskeletal Radiology
Rachel L Umans, Benjamin D Umans, Hilary Umans, Elisabeth Elsinger
PURPOSE: To identify correlated signs on non-enhanced MRI that might improve diagnostic detection of plantar plate (PP) tear. MATERIALS AND METHODS: We performed an IRB-approved, HIPAA-compliant retrospective analysis of 100 non-contrast MRI (50 PP tear, 50 controls). All were anonymized, randomized, and reviewed; 20 were duplicated to assess consistency. One musculoskeletal radiologist evaluated qualitative variables. A trained non-physician performed measurements...
July 2016: Skeletal Radiology
Vanessa Dinoá, Felipe von Ranke, Flavia Costa, Edson Marchiori
OBJECTIVE: To present findings of plantar plate (PP) lesions from MRI with administration of gadolinium and to differentiate PP lesions from others causes of metatarsalgia. MATERIALS AND METHODS: Two musculoskeletal radiologists reviewed 249 contrast-enhanced forefoot MRI scans from patients with metatarsalgia between June 2012 and June 2013. Evaluations focused on hyper-vascularized/fibrous tissue and other findings associated with PP tears. RESULTS: Fifty-nine patients had PP tears, 59 % were female...
May 2016: Skeletal Radiology
Caio Nery, Michael J Coughlin, Daniel Baumfeld, Fernando C Raduan, Tania Szejnfeld Mann, Fernanda Catena
Although metatarsophalangeal (MTP) plantar plate tears are common, they are still often missed. The purpose of this study is to find the best clinical variables to define and grade the plantar plate injuries. Sixty-eight patients (100 MTP joints) were graded arthroscopically and divided into five groups (0 to IV) according to the anatomical classification. Their medical records were reviewed to establish correlations of clinical findings with the anatomical lesions. The positive correlations found were acute pain, widening of the interdigital space, loss of ground touch, positivity of the MTP joint drawer test, reduction of the toe purchase, and toe supination...
2014: Journal of Surgical Orthopaedic Advances
Erin E Klein, Lowell Weil, Lowell Scott Weil, Michael Bowen, Adam E Fleischer
UNLABELLED: There is uncertainty regarding the most accurate and cost-effective method for diagnosing plantar plate injuries within the foot. The purpose of this study was to examine the combined value of using clinical and radiographic findings to diagnose high grade tears (> 50% disruption) within the second metatarsophalangeal (MTP) joint. Ninety-eight consecutive patients (117 feet) who underwent corrective surgery for plantar forefoot pain at a single foot and ankle specialty clinic were included in this retrospective analysis...
December 2014: Foot & Ankle Specialist
Catherine A Feuerstein, Lowell Weil, Lowell Scott Weil, Erin E Klein, Adam Fleischer, Nicholas G Argerakis
Musculoskeletal ultrasound (US) is a common modality used to examine plantar plate pathology. Comparison of the diagnostic accuracy of static versus dynamic ultrasound has not been previously published. The objective of this study was to prospectively compare the value of using preoperative static and dynamic ultrasound findings to diagnose plantar plate pathology using intraoperative inspection as the standard of reference. Patients attending a single foot and ankle specialty clinic from August 2012 to June 2013 with clinically suspected plantar plate pathology that was unresponsive to conservative care served as the study population...
July 15, 2014: Foot & Ankle Specialist
Wenjay Sung
Lesser metatarsophalangeal joint instability is a challenging disorder for the foot and ankle surgeon to repair. We believe that disruption of the plantar plate is common, and its repair should be carefully considered. However, we believe that most current techniques inadequately address repair of the complete plantar plate ligament tear, and, thus, instability and pain commonly persist after disruption of the plantar plate. In the present report, we present a technique we have found useful for repair of a complete plantar plate ligament rupture...
May 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Caio Nery, Michael J Coughlin, Daniel Baumfeld, Fernando C Raduan, Tania Szejnfeld Mann, Fernanda Catena
BACKGROUND: Instability of the lesser metatarsophalangeal (MTP) joints is a common cause of deformity and pain. The purpose of this study was to prospectively evaluate the surgical outcomes for the different grades of plantar plate tears and propose a treatment protocol. METHODS: Sixty-eight patients (100 MTP joints) were prospectively enrolled and graded according to the anatomical grade system for plantar plate tears. Based on this classification, the appropriate surgical procedure was chosen as follows: grades 0 and I, thermal shrinkage with radiofrequency; grades II and III, direct reinsertion of the plantar plate; and grade IV, flexor-to-extensor tendon transfer...
September 2014: Foot & Ankle International
Hilary Umans, Ramya Srinivasan, Elisabeth Elsinger, Gregory E Wilde
OBJECTIVE: To identify the variety of second and third intermetatarsal space (IS) lesions that may coexist with and without adjacent metatarsophalangeal joint (MTP) plantar plate (PP) tears. MATERIALS AND METHODS: One hundred forefoot MRIs in 96 patients with metatarsalgia obtained between 30 September 2011 and 21 July 2012 using 1.5- or 3-T MRI were retrospectively reviewed in consensus by two MSK radiologists and one podiatrist (DPM). MRI was evaluated for second and third MTP PP tear and the presence/nature of second and third IS lesions...
October 2014: Skeletal Radiology
Troy S Watson, Dorian Y Reid, Timothy L Frerichs
UNLABELLED: In recent years, the role of the plantar plate in lesser metatarsophalangeal joint stability has increasingly been recognized. Tearing or attenuation of the plantar plate often will result in crossover or hammertoe deformity with hyperextension of the MTP joint. Some patients are able to have resolution of painful symptoms with conservative treatment but for those that fail these measures, surgical fixation of the plantar plate is indicated. While, there have been some described techniques for direct repair of the plantar plate, we present a surgical technique through a dorsal approach with a Weil osteotomy which accomplishes great clinical correction of the plantar plate tear and associated toe deformity as well as relief of patient's pain...
July 2014: Foot & Ankle International
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