How to classify plantar plate injuries: parameters from history and physical examination

Abstract

ObjectiveTo find the best clinical parameters for defining and classifying the degree of plantar plate injuries.MethodSixty-eight patients (100 metatarsophalangeal joints) were classified in accordance with the Arthroscopic Anatomical Classification for plantar plate injuries and were divided into five groups (0 to IV). Their medical files were reviewed and the incidence of each parameter for the respective group was correlated. These parameters were: use of high heels, sports, acute pain, local edema, Mulder's sign, widening of the interdigital space, pain in the head of the corresponding metatarsal, touching the ground, “drawer test”, toe grip and toe deformities (in the sagittal, coronal and transversal planes).ResultsThere were no statistically significant associations between the degree of injury and use of high-heel shoes, sports trauma, pain at the head of the metatarsal, Mulder's sign, deformity in pronation or displacement in the transversal and sagittal planes (although their combination, i.e. “cross toe”, showed a statistically significant correlation). Positive correlations with the severity of the injuries were found in relation to initial acute pain, progressive widening of the interdigital space, loss of “touching the ground”, positive results from the “drawer test” on the metatarsophalangeal joint, diminished grip strength and toe deformity in supination.ConclusionsThe “drawer test” was seen to be the more reliable and precise tool for classifying the degree of plantar plate injury, followed by “touching the ground” and rotational deformities. It is possible to improve the precision of the diagnosis and the predictions of the anatomical classification for plantar plate injuries through combining the clinical history and data from the physical examination.

Early Outcomes Following Plantar Condylectomy and Imbrication of Plantar Plate to Metatarsal Neck for Metatarsalgia and Grade 0 Lesser Toe Metatarsophalangeal Joint Instability

“…34 More recently, magnetic resonance imaging (MRI) has been demonstrated to have high sensitivity and specificity in identifying plantar plate lesions, particularly useful with high clinical suspicion for a plantar plate tear and an equivocal examination. 22,33 Conservative treatment of lesser MTP instability, including the use of cushioned insoles, metatarsal padding, and adjacent toe taping, has been shown to relieve pain and slow progression of deformity in early stages. 6,7 However, plantar plate tissue has poor regenerative properties, similar to those of knee menisci, and is unlikely to heal spontaneously.…”

“…Grade 4 (buttonhole or combined transverse/longitudinal and degeneration) lesions were addressed via flexor-to-extensor tendon transfer due to irreparable plantar plate damage. 7,18,20,22 Although management of advanced plantar plate and collateral ligament lesions have been extensively reviewed in orthopaedic literature, the optimal treatment for grade 0 MTP joint instability lesions remains poorly understood. Grade 0 lesions are characterized by pain at the metatarsal head without a discrete tear or MTP deformity, 8 often leading to a delay in diagnosis due to their similarity in presentation to capsulitis or synovitis.…”

“…34 More recently, magnetic resonance imaging (MRI) has been demonstrated to have high sensitivity and specificity in identifying plantar plate lesions, particularly useful with high clinical suspicion for a plantar plate tear and an equivocal examination. 22,33…”

“…Grade 4 (buttonhole or combined transverse/longitudinal and degeneration) lesions were addressed via flexor-to-extensor tendon transfer due to irreparable plantar plate damage. 7,18,20,22…”