plantar plate of metatarsophalangeal joint ( RID3134 )
Although the primary signs of plantar plate (PP) tear are clear, with an obvious fluid signal defect lateral to midline at the insertion onto the base of the prox phalanx (red arrows slide 1,2), this nicely illustrates correlated signs of tear; which include tibial deviation of the 2nd toe, a small enthesophyte at the plantar lateral base of the 2nd toe (white arrow slide 1), and minimal flexor tenosynovitis. There is 2nd MTPJ synovitis; the PP tear permits pathologic communication between the joint and flexor tendon sheath. That is the basis for MTPJ arthrography to diagnose PP tear, which (in my opinion) is unnecessary. Note the capsular and pericapsular soft tissue thickening and edema which encroaches on the fat planes of the 2nd interspace. These correlated signs can be useful when tear is less obvious or even occult.
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