Underlying Osseous Deformity in Plantar Plate Tears

NewsBot · Oct 23, 2012

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The Underlying Osseous Deformity in Plantar Plate Tears
A Radiographic Analysis
Erin E. Klein, Lowell Weil Jr, Lowell Scott Weil Sr, Jessica Knight,
Foot Ankle Spec October 22, 2012

Purpose. Plantar plate tears can cause pain and deformity of the forefoot. The purpose of this study is to correlate common radiographic findings with observed intra-operative pathology in patients with plantar plate pathology.

Methods. Bilateral weight-bearing radiographs were reviewed for 88 patients (106 feet) who underwent surgical repair of suspected plantar plate pathology. Parameters reviewed included the first intermetatarsal angle, the metatarsus adductus angle, the second and third metatarsophalangeal angles, splaying of the second and third toes, evaluation of the metatarsal parabola by 3 different methods, the first and second lateral declination angles, and the second lateral metatarsophalangeal angle.

Results. Of 106 feet, 97 had intra-operative plantar plate tears. The radiographs of patients with plantar plate tears had an increased amount of digital splay on the anteroposterior radiograph compared to patients without pathology. For patients with unilateral plantar plate pathology, the metatarsal parabola of the symptomatic foot was compared with that of the asymptomatic foot. A significantly increased second metatarsal protrusion distance as measured by 2 different methods was noted in the symptomatic foot. Odds ratios revealed that patients with an intermetatarsal angle >12, medial deviation of the second toe, and splaying of the digits were more likely to be diagnosed with a plantar plate tear intra-operatively.

Conclusion. Although radiographs do not definitively diagnose plantar plate tears, understanding osseous forefoot architecture will aid with diagnosis in the absence of other osseous pathology. Furthermore, these data suggest that parabola should be corrected to maintain long-term correction of plantar plate pathology.
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Admin2 · Oct 23, 2012

Related threads:
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Plantar Plate Anatomy re Plantar plate tear
Lesser metatarsophalangeal instability: presentation, management, and outcomes.
MRI and plantar plate dysfunction
Vibram Five Fingers and Plantar Plate Dysfunction
Metatarsophalangeal Joint Pathology in Crossover 2nd Toe Deformity: A Cadaveric Study
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NewsBot · Jan 18, 2017

Association of Abnormal Metatarsal Parabola With Second Metatarsophalangeal Joint Plantar Plate Pathology
Adam E. Fleischer, DPM, MPH, Erin E. Klein, DPM, MS, Maheen Ahmad, MPH, Shivang Shah, MS, Fernanda Catena, MD, Lowell Scott Weil, DPM, Lowell Weil, DPM, MBA
Foot & Ankle International; in press

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. Patients presenting for pain outside of the forefoot served as the control group. Controls were matched on age (±2 years), gender, and year of presentation. Weight-bearing foot x-rays were assessed for several predetermined angular relationships by a single rater. Conditional logistic regression was used to identify risk factors for plantar plate injury.

Results:
A long second metatarsal, defined as a metatarsal protrusion index less than −4 mm, was the only significant risk factor for plantar plate pathology in both the univariate and multivariable analyses (multivariate odds ratio 2.5 [95% confidence interval 1.8 to 3.3], P = .002).

Conclusion:
We found that a long second metatarsal was a risk factor for developing second metatarsophalangeal joint plantar plate tears. This knowledge may aid foot and ankle surgeons when contemplating the need for second metatarsal shortening osteotomies (eg, Weil osteotomy) during plantar plate surgery and when deciding on the amount of shortening for second metatarsal osteotomies.
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NewsBot · Jan 20, 2021

Is Second Metatarsal Protrusion Related to Metatarsophalangeal Plantar Plate Rupture?
Tania S Mann et al
AJR Am J Roentgenol. 2021 Jan;216(1):132-140

OBJECTIVE. The purpose of this study was to determine whether the relative length of protrusion of the second metatarsal, measured on MRI and weight-bearing foot radiography, predicts the diagnosis of second metatarsophalangeal (MTP) joint plantar plate (PP) tear on MRI. MATERIALS AND METHODS. We retrospectively evaluated 166 consecutive patients (211 feet). Patients had undergone weight-bearing foot radiography and forefoot MRI. Using the Coughlin method, two independent observers measured second meta-tarsal protrusion length on radiography and MRI. MRI findings were classified as normal PP, complete PP tear, or degenerative or partial PP tear. RESULTS. Patients had a mean age of 47 ± 14.6 (SD) years, and 131 (78.9%) were women. MRI measurements were highly correlated with radiographic measurements (r = 0.882; 95% CI, 0.866-0.898; p < 0.001). A significant correlation was found between length of protrusion and cases classified as either normal PP or PP tear. Patients with a normal PP had a mean protrusion length of 4.11 ± 1.35 mm on radiographs and 2.61 ± 1.31 mm on MR images, whereas those with a PP tear had a mean protrusion length of 4.75 ± 1.53 and 3.05 ± 1.34 mm, respectively. ROC curve analysis showed that protrusion length cutoff values of 5.47 mm measured on radiographs and 3.17 mm on MR images were correlated with MTP PP tear. CONCLUSION. We identified a linear correlation between second metatarsal protrusion measured on MRI and that measured on radiography, with values about 35% higher for the latter. Our study showed an association between length of protrusion of the second metatarsal and PP rupture and identified a cutoff value for the second meta-tarsal overlength that is associated with these tears.
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