Plantar plate tear

BACKGROUND: Metatarsalgia and plantar plate tears are characterized by forefoot pain and toe deformity in severe cases. Conservative management may slow progression of symptoms; however, definitive treatment often requires operative intervention. The purpose of this observational study was to evaluate the combination of plantar condylectomy and surgical imbrication of the plantar plate to the metatarsal neck to repair grade 0 plantar plate injuries. METHODS: We retrospectively identified 22 patients with metatarsalgia and low-grade plantar plate lesions (grade 0), operated between 2018 and 2021, who underwent operative repair involving plantar metatarsal condylectomy and proximal surgical imbrication of the plantar plate to the metatarsal neck...

PURPOSE OF REVIEW: First metatarsophalangeal joint sprains or turf toe (TT) injuries occur secondary to forceful hyperextension of the great toe. TT injuries are common among athletes, especially those participating in football, soccer, basketball, dancing, and wrestling. This review summarizes the current treatment modalities, rehabilitation protocols, and return-to-play criteria, as well as performance outcomes of patients who have sustained TT injuries. RECENT FINDINGS: Less than 2% of TT injuries require surgery, but those that do are typically grade III injuries with damage to the MTP joint, evidence of bony injury, or severe instability...

INTRODUCTION: Injuries of the great toe are common sports-related injuries; however, isolated traumatic plantar plate tears at the interphalangeal (IP) joint are relatively rare. Here, we present a pediatric case of a chronic plantar plate tear of the IP joint of the great toe that was difficult to diagnose definitively, which delayed surgical treatment. CASE REPORT: An 11-year-old girl was injured when she collided with her right great toe while using a jump box during gymnastics...

Injuries to the plantar plate complex of the first toe and the lesser toes, although closely related anatomically, differ significantly in their pathogenesis. Lesser metatarsophalangeal joint plantar plate degeneration and tear typically presents as an attritional pattern of capsuloligamentous deficiency in middle-aged patients, whereas first metatarsophalangeal joint capsuloligamentous injury is typically acute and occurs in younger adult athletes engaged in sports involving repetitive running and jumping...

Foot and ankle injuries are common musculoskeletal disorders. In the acute setting, ligamentous injuries are most common, whereas fractures, osseous avulsion injuries, tendon and retinaculum tears, and osteochondral injuries are less common. The most common chronic and overuse injuries include osteochondral and articular cartilage defects, tendinopathies, stress fractures, impingement syndromes, and neuropathies. Common forefoot conditions include traumatic and stress fractures, metatarsophalangeal and plantar plate injuries and degenerations, intermittent bursitis, and perineural fibrosis...

Capsuloligamentous injury of the first metatarsophalangeal (MTP) joint (eponymously called "turf toe") mostly occurs in athletes and involves acute trauma, whereas tears of the lesser MTP joint plantar plate typically are an attritional-degenerative condition. This article reviews the anatomy, pathophysiology, mechanism and patterns of injury, grading and classification of injury, imaging appearances (pre- and postoperative), and management of first MTP joint capsuloligamentous injuries and lesser MTP joint plantar plate tears...

BACKGROUND: Most plantar plate tears of the first metatarsophalangeal joint can be treated successfully by nonoperative means. Primary repair may be indicated to restore continuity of the plantar structures and joint stability. Inadequate or failed nonoperative treatment may cause persistent pain and disability and thereby represent a career-threatening injury to an athlete. The chronic plantar plate tears are difficult both to diagnose and to treat. When surgical treatment is indicated, traditionally a wide plantar or 2 parallel incisions are used...

BACKGROUND: The plantar plate is a major stabilizing structure of the metatarsophalangeal (MTP) joint with instability frequently occurring after a tear or attenuation of this structure. Commonly, a McGlamry elevator is used to strip the plantar plate from the plantar surface of the metatarsal to improve exposure of the MTP joint. The anatomy of the proximal plantar plate and vascular consequence of stripping the plantar plate from the metatarsal is not yet well understood. The purpose of this study is to describe the proximal attachment of the plantar plate anatomically and quantify the relative contribution of blood supply to the proximal plantar plate from both the metatarsal and the plantar fascia...

BACKGROUND: We hypothesized that there would be a comparable and high incidence of an incidental torn plantar plate on routine magnetic resonance imaging (MRI) in asymptomatic patients. METHODS: We included adult patients undergoing a foot MRI from 2019 to 2020. Based on the documented reason for MRI, patients were divided into symptomatic and asymptomatic. A separate musculoskeletal radiologist re-evaluated MRI images. Findings were categorized as "torn vs intact...

BACKGROUND: Lesser toe metatarsophalangeal joint (MTPJ) instability, secondary to plantar plate tear, has been the focus of numerous recent publications, the majority reporting on repair through a dorsal approach. A plantar approach has been described with the advantage of direct ligamentous repair or repair to bone, which follows conventional techniques employed throughout the body. Previous clinical studies have shown success in deformity correction and the longevity of both approaches...

Forefoot pain is common in clinical practice. Careful history taking and routine physical examination are initially performed for diagnosis, but imaging can confirm the clinical suspicion and play a key role in management. Ultrasound (US) can provide a visualization of the fine anatomy of the forefoot and is a useful method for evaluating various lesions causing forefoot pain. In this review, we provide the detailed anatomical structures of the forefoot and their normal appearances on US. We also focus on the most common pathologies affecting the forefoot, including plantar plate tear, sesamoiditis, bone fracture, synovitis, tenosynovitis, bursitis, Morton's neuromas, and foreign bodies...

The plantar plate is a known stabilizer of the lesser toe metatarsophalangeal (MTP) joint. MTP instability is a known common cause of metatarsalgia, most commonly in the second toe. In the last decade, clinical staging and anatomic grading mechanisms have been published to guide the surgeons on the treatment of MTP instability; this has also led to an understanding of how plantar plate tears relate to MTP joint instability. Direct surgical repair of the plantar plate has been described, short-term outcomes have been published, and the results are not perfect, but promising with respect to patient satisfaction and pain relief...

The plantar plate is a critical structure involved in stabilizing the metatarsophalangeal joint. Its disruption can not only be painful for the patient but also may lead to subsequent structural deformities. There are several conservative treatment modalities available to help mitigate symptoms including splinting, offloading, and intraarticular injections. That being said, once the pathology progresses to advanced stages, these treatments are not efficacious. Reported success with conservative treatment modalities is limited to case studies and series with a low level of clinical evidence...

BACKGROUND: Previous literature has suggested both MRI and ultrasound can accurately diagnose plantar plate tears. There is a significant cost difference between these two modalities, sparking interest for which should be the preferred method for diagnosis. PURPOSE: The purpose of this study was to examine the diagnostic accuracy of MRI and dynamic, musculoskeletal ultrasound for lesser metatarsal plantar plate injuries using a systematic review and meta-analysis...

OBJECTIVE: The magnetic resonance imaging diagnostic criteria for a complete tear of metatarsophalangeal plantar plate are well-established. However, more subtle abnormalities can also occur and be a source of pain. The objective of this study is to determine the prevalence of degenerative plantar plate injuries in patients with metatarsalgia who underwent forefoot magnetic resonance imaging and describe the main abnormalities found. The hypothesis is that mild capsular fibrosis will have high sensitivity but low specificity for plantar plate degenerative injuries...

No abstract text is available yet for this article.

BACKGROUND: The plantar plate is an important static stabilizer of the lesser metatarsophalangeal joints, and disruptions of the plantar plate can lead to significant instability and lesser toe deformities. In recent years, direct plantar plate repair has been proposed. Although direct repair via a dorsal approach is attractive, a torn plantar plate is small and difficult to access using regular instruments in a restricted operative field. METHODS: In this report, a unique method for plantar plate repairs was used to repair various configurations of plantar plate tears with standard operative instruments that are available in most operating rooms...

Turf toe is a common injury of the hallux metatarsophalangeal (MTP) joint in athletes which is the result of hyperdorsiflexion injury. While the term turf toe has been used to describe a variety of first MTP joint injuries, the term is now typically used in imaging to describe tearing or injury to the plantar plate complex. This review article will cover normal anatomy of the first MTP joint, mechanism of injury, typical imaging findings in normal individuals on MRI and ultrasound, as well as the most common patterns of injury...

A 45-year-old man presented with severe pinch-point crush injury to his left foot. Plain radiographs revealed dislocation of the first metatarsophalangeal joint and dorsolateral dislocation of the basal phalanx and sesamoids. The first tarsometatarsal joint was subluxed in the plantar direction and the second to fourth tarsometatarsal joints were subluxed dorsally. The sesamoids were displaced dorsolateral to the metatarsal head. There was a longitudinal tear of the joint capsule at the medial margin of the medial sesamoid, which was sutured together with the abductor hallucis tendon and collateral ligament...

BACKGROUND: Recent surgical techniques have focused on anatomic repair of lesser toe metatarsophalangeal (MTP) plantar plate tears, yet it remains unknown whether the plantar plate has the biological capacity to heal these repairs. Therefore, a better understanding of the plantar plate vasculature in response to injury may provide further insight into the potential for healing after anatomic plantar plate repair. Recently, a study demonstrated that the microvasculature of the normal plantar plate is densest at the proximal and distal attachments...