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Sonography of Plantar Plates in Cadavers: Correlation with MRI and Histology AJR 2006; 186:948-955
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OBJECTIVE. The purpose of our study was to describe the sonographic appearance of the lesser metatarsal plantar plates in cadavers and to correlate these findings with MRI and histology.
MATERIALS AND METHODS. Six soft-embalmed cadaveric feet (74–92 years old; two male, one female) were imaged with sonography and MRI. Tear dimensions of the plantar plate were recorded in the long and short axes. Orthopedic surgeons directly inspected the plantar plates before removing samples for histologic correlation. One young fresh cadaver was imaged with sonography before histologic assessment.
RESULTS. The normal plantar plate appearance on sonography was a slightly echoic, homogeneous, curved structure. At direct inspection, a tear was present in 23 (96%) of 24 of the lesser plantar plates in the soft-embalmed feet. This direct inspection correlated with sonography detecting 23 tears correctly and MRI, 22 tears. Both sonography and MRI falsely reported one tear, but MRI also failed to detect one tear. Histologically, the abnormal plantar plate showed loss of the normal dense regular tissue and replacement with vessels, hydropic tissue, and a mixture of loose connective tissue and dense irregular connective tissue.
CONCLUSION. Sonography, being noninvasive, shows promise as an imaging tool of the plantar plate. With ongoing research in this area we hope to determine the reliability and significance of such a technique in the evaluation of the plantar plate.
Sonographic and MRI evaluation of the plantar plate: a prospective study. Eur Radiol. 2006 Jul 4;
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The purpose of this study was to establish the accuracy of ultrasound in the examination of the plantar plate by comparing it with MRI, or if available, surgical findings. The lesser metatarsophalangeal joint plantar plates of 40 symptomatic and 40 asymptomatic feet (160 asymptomatic and 160 symptomatic plantar plates) were examined with ultrasound and MRI. Patients treated with surgery were chosen on a clinical basis and provided surgical correlation for the imaging techniques. Symptomatic patients with metatatarsalgia and suspected metatarsophalangeal joint instability were referred by an orthopedic foot specialist; asymptomatic feet were obtained either through examination of the contralateral foot of the symptomatic patients or volunteers. Ultrasound detected 75/160 and 139/160 plantar plates torn in the asymptomatic and symptomatic groups, respectively. MRI detected 56/160 and 142/160 tears in the symptomatic and asymptomatic groups, respectively. The sensitivity of MRI and ultrasound with surgical correlation was calculated to be 87 and 96%, respectively, with poor specificity. Ultrasound correlates moderately with MRI in the evaluation of the plantar plate. Surgical correlations, although limited (n=10), indicate ultrasound is superior to MRI with more accurate detection of tears.
Plantar plate and second ray syndrome: Normal and pathological US imaging features and proposed US classification
Borne J, Bordet B, Fantino O, Bousquet JC, Coillard JY, Pialat JB. J Radiol. 2010 May;91(5 Pt 1):543-8.
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Second ray syndrome is due to degenerative changes of the plantar plate frequently associated to hallux valgus that may require dedicated surgical correction. An US classification is proposed and its impact on patient management is assessed. A total of 52 patients with hallux valgus and associated metatarsal pain scheduled for surgery were imaged. US resulted in modification of the treatment plan in 32% of patients. The surgical procedure was modified due to a plantar plate lesion not suspected on clinical and routine imaging findings. US improves the surgical management of patients with hallux valgus and second ray syndrome.
Ultrasound of the plantar plate
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