Plantar plate tears

[Linh]

Hi Steve,

I scanned this forefoot and saw several partial plantar plate tears at 2nd and 3rd toes. However, as I scanned the 1st, I noted that this has the same appearance on the other side. I am not sure if this is a partial plantar plate tear of the 1st toe as I know the 1st plantar plate is morphologically different than the rest of other toes?

Do you grade the plantar plate tears? What is the difference in management if we grade them?
Or do you just describe it if it is partial tear /full thickness partial width/ complete transection?

Best regards,
Linh

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[Stephen Bird]

Hi Linh,

This is a normal plate,

the black area you have measured is some synovial fluid between the plantar plate and the hyaline cartilage of the metatarsal head.

The plantar plate IS the joint capsule so fluid immediately under it is joint fluid.

The location of your fluid is not the location where a plantar plate likes to tear.

Plantar plates tear from the base of the proximal phalanx at the lateral aspect of the plate.
It is a predictable pattern.

The key findings are that the base of the proximal Px enthesis becomes irregular when the plate is torn from it. There will be a defect in the adjacent plate, and also when you stress test it there will be a disconnect between the base of the Px and the plate.

Read the plantar plate article in the “journal articles” section of the website and it will help you to understand plate tears.

Steve

[Samuel Katumba]

Hi Steve,
See attached images of plantar right foot.
One cyst had speckled appearance ? intracyst bleed.
Also, I thought them as ganglion cysts but how do I differentiate ganglion cyst from intermetartasal bursitis?
Thanks

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[Stephen Bird]

Hi Samuel,

This is a little tricky from the images.

The area you are imaging looks to be seperate from the plantar plate. More towards the plantar aspect.
I am wondering if this is an area of adventitial bursa formation.
Was it hard on palpation or was it a little spongy?

You can get “para-plate cysts” which is a small synovial fluid leak through the
central part of the plate, and these are rarely clinically important. They are hard like a small ganglion and similar in ethology to a paralabral or paramedical cyst. The area you have photographed is much larger than these typically are.

I can see it has no flow in it.

It looks like it arises from the proximal portion of the MTP joint from the area where the joint capsule attaches to the metatarsal shaft at the proximal end of the MTP joint.

So what could it be:

Ganglion arising from the MTP joint.

Adventitial bursa.

I don’t think it is diagnostic of a plate tear.

It is not in the correct location for an inter metatarsal bursa or Morton Neuroma.

Please give me any additional information you have and any follow up / subsequent imaging.

Nice work mate,

Steve.

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