Radiological approach to metatarsalgia in current practice: an educational review.

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Abstract

Conflict of interest statement: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: University Hospitals of Angers and Rennes guidelines do not require individual consent for the publication of images, as long as they are anonymized. Competing interests: The authors declare that they have no known competing interests. 17. Skeletal Radiol. 2021 Aug;50(8):1513-1525. doi: 10.1007/s00256-020-03708-1. Epub 2021 Jan 10. Ultrasound findings of plantar plate tears of the lesser metatarsophalangeal joints. McCarthy CL(1), Thompson GV(2). Author information: (1)Oxford Musculoskeletal Radiology, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK. catherinemccarthy@doctors.org.uk. (2)Oxford Musculoskeletal Radiology, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK. Lesser metatarsophalangeal (MTP) joint plantar plate tears are a common and increasingly recognised cause of metatarsalgia, MTP joint instability and forefoot deformity. Increased interest in early accurate diagnosis of plantar plate tears follows recent surgical innovations allowing direct plantar plate repair. The purpose of this review is to describe the ultrasound features of normal lesser MTP joint plantar plates and to characterise and illustrate the direct and indirect ultrasound findings of plantar plate tears. Lesser MTP joint plantar plate tears are most commonly located at the 2nd MTP joint, involving the lateral distal plantar plate insertion with variable propagation medially and proximally. The most common ultrasound appearance of a plantar plate tear is a discrete partial or full thickness hypoechoic defect in the plate substance. Flattening and attenuation or non-visualisation of the plantar plate represent more extensive tears. Dynamic imaging with toe dorsiflexion improves visualisation of tears and augments MTP joint subluxation. A common indirect finding is pericapsular fibrosis along the MTP joint capsule adjacent to a plantar plate tear, which requires differentiation from Morton's neuroma, and key distinguishing features at ultrasound are described. Other indirect findings include the cartilage interface sign, flexor tendon subluxation onto the metatarsal head or medial to the midline, flexor tenosynovitis, proximal phalangeal enthesophytes or avulsion and MTP joint synovitis. Ultrasound offers several advantages over MR imaging but requires a meticulous ultrasound examination, and optimisation of scanning technique is described. DOI: 10.1007/s00256-020-03708-1