European Radiology

, Volume 16, Issue 12, pp 2661–2669 | Cite as

Sonographic and MRI evaluation of the plantar plate: a prospective study

  • Julie GreggEmail author
  • Morry Silberstein
  • Timothy Schneider
  • Paul Marks


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 Fibrocartilage Metatarsophalangeal joint Metatarsalgia Instability 


  1. 1.
    Gazdag A, Cracchiolo A (1998) Surgical treatment of patients with painful instabilility of the second metatarsophalangeal joint. Foot Ankle 19:137–143PubMedGoogle Scholar
  2. 2.
    Yu GV, Judge MS, Hudson JR, Seidelmann F (2002) Predislocation syndrome. J Am Podiatr Med Assoc 92:182–199PubMedGoogle Scholar
  3. 3.
    Coughlin MJ (1993) Second metatarsophalangeal joint instability in the athlete. Foot Ankle 14:309–319PubMedGoogle Scholar
  4. 4.
    Powless SH, Elze M (2001) Metatarsophalangeal joint capsule tears: an analysis by arthrography, a new classification system and surgical management. J Foot Ankle Surg 40:374–389PubMedCrossRefGoogle Scholar
  5. 5.
    Yao L, Do HM, Cracchiolo A, Farahani K (1994) Plantar plate of the foot: findings on conventional arthrography and MR imaging. AJR 163:641–644PubMedGoogle Scholar
  6. 6.
    Yao L, Cracchiolo A, Farahani K, Seeger LL (1996) Magnetic resonance imaging of plantar plate rupture. J Foot Ankle Int 17:33–36Google Scholar
  7. 7.
    Umans HR, Elsinger E (2001) The plantar plate of the lesser metatarsophalangeal joints: potential for injury and role of MR imaging. Magn Reson Imaging Clin N Am 9:659–669PubMedGoogle Scholar
  8. 8.
    Blitz NM, Ford LA, Christensen JC (2004) Second metatarsophalangeal joint arthrography: A cadaveric correlation study. J Foot Ankle Surg 43:231–240PubMedCrossRefGoogle Scholar
  9. 9.
    Mohana-Borges AV, Theumann NH, Pfirrmann CW, Chung CB, Resnick DL, Trudell DJ (2003) Lesser metatarsophalangeal joints: Standard MR imaging, MR arthrography, and MR bursography - Initial results in 48 cadaveric joints. Radiology 227:175–182PubMedGoogle Scholar
  10. 10.
    Gregg J, Silberstein M, Schneider T, Kerr J, Marks P (2006) Sonography of plantar plates in cadavers: correlation with MRI and histology. AJR 186: 948–955PubMedCrossRefGoogle Scholar
  11. 11.
    Kuwada GT, Dockery GL (1980) Modification of the flexor tendon transfer procedure for the correction of flexible hammertoes. J Foot Surg 19:38–40PubMedGoogle Scholar
  12. 12.
    Deland JT, Sobel M, Arnoczky SP, Thompson FM (1992) Collateral ligament reconstruction of the unstable metatarsophalangeal joint: an in vitro study. Foot Ankle 13:391–395PubMedGoogle Scholar
  13. 13.
    Mann RA, Chou LB (1995) Surgical management for intractable metatarsalgia. Foot Ankle Int 16:322–327PubMedGoogle Scholar
  14. 14.
    Slovenkai MP, Linehan D, McGrady L, Lim TH, Harris GF, Shereff MJ (1995) Comparison of two fixation methods of oblique lesser metatarsal osteotomies: a biomechanical study. Foot Ankle Int 16:437–439PubMedGoogle Scholar
  15. 15.
    Ford LA, Collins KB, Christensen JC (1998) Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate. J Foot Ankle Surg 37:217–222PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Julie Gregg
    • 1
    Email author
  • Morry Silberstein
    • 2
  • Timothy Schneider
    • 3
  • Paul Marks
    • 4
  1. 1.Mayne Health Diagnostic ImagingVaucluse HospitalBrunswickAustralia
  2. 2.Monash Medical SchoolThe Alfred HospitalPrahranAustralia
  3. 3.Melbourne Orthopaedic GroupWindsorAustralia
  4. 4.Mayne Health Diagnostic ImagingThe Avenue HospitalWindsorAustralia

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