〈 Clinical Research 〉 The Underlying Osseous Deformity in Plantar Plate TearsAnalysis

" Abstract: Purpose. Plantar plate tears can cause pain and deformity of the forefoot. The purpose of this study is to correlate common radio- graphic findings with observed intra- operative pathology in patients with plantar plate pathology. Methods. Bilateral weight-bearing radiographs were reviewed for 88 patients (106 feet) who underwent surgical repair of suspected plantar plate pathol- ogy. Parameters reviewed included the first intermetatarsal angle, the metatarsus adductus angle, the sec- ond and third metatarsophalangeal angles, splaying of the second and third toes, evaluation of the metatar- sal parabola by 3 different methods, the first and second lateral declina- tion angles, and the second lateral metatarsophalangeal angle. Results. Of 106 feet, 97 had intra-operative plantar plate tears. The radiographs of patients with plantar plate tears had an increased amount of digi- tal splay on the anteroposterior radio- graph compared to patients without pathology. For patients with unilateral plantar plate pathology, the metatar- sal parabola of the symptomatic foot was compared with that of the asymp- tomatic foot. A significantly increased second meta tarsal protr usion dis- tance as measured by 2 diff erent methods was noted in the symptom - atic foot. Odds ratios r evealed that patients with an intermetatar- sal angle >12, medial deviation of the second toe, and splaying of the digits were more likely to be diagnosed with a plantar plate tear intra- operatively. Conclusion. Although radiographs do not definitively diagnose plantar plate tears, understanding osseous forefoot architecture will aid with diagnosis in the absence of other osseous pathology. Furthermore, these data suggest that parabola should be corrected to maintain long-term cor- rection of plantar plate pathology.