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I have been working with a 39 year old male patient who was previously active running and biking non-competitively.

Patient suffered right foot trauma from a minor fall (3 feet) onto barre e feet 5 months ago.

There is visible swelling on the ball of the foot under mtpj #3 and 4 with swelling extending into toes. There is moderate pain when palpating mtpj 3 and 4, however patient reports most significant pain is due to tenderness of swollen area distal to mtpj 3 and 4 (plantar).

Weight bearing x-rays and drawer test show stability in those joints - so full rupture of plantar plate is unlikely. Also, patient does not indicate pain while associated joints are held in dorsiflexion.

First MRI ordered 2 months after initial fall was of low technical quality but did not show convincing evidence of plantar plate rupture.

A second MRI was ordered last week- there seems to be some evidence of plantar plate pathology - especially on mtpj #3. See attached SAG STIR MRI snap shot.

Patient has been in various boots, Hoka with orthotics, metatarsil pads - since injury with little sign of improvement.

Questions for the group:
1. Is signal indicated by arrow on attached MRI snap consistent with partial plantar plate rupture
2. Does the injury and chronic (5 month) swelling point to a plantar plate issue?
3. Any other ideas on how to proceed with treating this patient?

Thank you,
Reed