Chronic Plantar Plate Injury


Coronal T1 weighted scan shows the intact plantar plate of the second MTP jt. in contradistinction to the disrupted plantar plate of the third MTP jt.	Post-contrast coronal fs. scan shows enhancement in the synovium of the third MTP jt, as well as rim enhancement around the granulation tissue or forming bursa on the plantar aspect of the MTP jt.


A different example demonstrates disruption of the PP with dorsal subluxation of the base of the second proximal phalanx, and adventitial bursitis.	A coronal T2 weighted image shows to best advantage the concomitant adventitial bursitis.	On post-contrast enhanced images the plantar aspect of the MTP jt. enhances avidly, often in a rim-like fashion around the reactive bursitis.

Comments:

Chronic plantar plate injuries are the result of chronic hyperextension in relation to high-heeled shoes. It is a common cause of metatarsalgia, and it is often associated with synovitis, flexor tenosynovitis, and adventitial or intermetatarsal bursitis.

The diagnosis is based on the detection of an irregular, thick or discontinous plantar plate with signal changes plantar to the capsule of the metatarsophalangeal joints. Enhancement can be marked secondary to the granulation tissue, synovitis or bursitis associated with this process.