Fact-sheet: Plantar plate tear


Updated on 11/07/2024 at 10:57 AM

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Definition

Plantar plate tear is a partial or complete tear of the plantar plate of a metatarsophalangeal joint

Clinical features

Acute or chronic pain

Metatarsalgia

Deformity

May be associated with other arthropathies such as rheumatoid arthritis

Ultrasound

Anechoic area and discontinuity of the plantar plate, better seen with dynamic extension maneuvers.

MRI

Low-grade sprain:

  • Focal T2 hyperintensity of the plantar plate without tear

Complete tear:

  • Discontinuity with a fluid-like T2 hyperintense area of tear
  • Proximal retraction of the plantar aponeurosis
  • MTP hyperextension and/or associated varus/valgus

Associated findings:

  • Intra-articular effusion
  • Effusion within the flexor tendon sheath
  • Pseudo-neuroma sign: ill-defined, eccentric intermetatarsal soft tissue thickening, suggestive of associated peri-capsular fibrosis
  • Distance between the plantar plate and the base of P1 >2.75mm

Differential diagnosis

Morton neuroma

Bursitis