1
|
Afonso PD, Britto SV, Spritzer CE, Martins E Souza P. Differential Diagnosis of Metatarsalgia. Semin Musculoskelet Radiol 2023; 27:337-350. [PMID: 37230133 DOI: 10.1055/s-0043-1764388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Lesser (or central) metatarsalgia is defined as pain in the forefoot under or around the lesser metatarsals and their respective metatarsophalangeal joints. Two common causes of central metatarsalgia are Morton's neuroma (MN) and plantar plate (PP) injury. Because both clinical and imaging features overlap, establishing the correct differential diagnosis may be challenging. Imaging has a pivotal role in the detection and characterization of metatarsalgia. Different radiologic modalities are available to assess the common causes of forefoot pain, so the strengths and weakness of these imaging tools should be kept in mind. It is crucial to be aware of the pitfalls that can be encountered in daily clinical practice when dealing with these disorders. This review describes two main causes of lesser metatarsalgia, MN and PP injury, and their differential diagnoses.
Collapse
Affiliation(s)
- P Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
- Radiology Department, Hospital Particular da Madeira, Grupo HPA, Funchal, Portugal
| | - Sabrina Veras Britto
- Radiology Department, Clinica Radiológica Luiz Felippe Mattoso, Gupo Fleury, Rio de Janeiro, Brazil
| | - Charles E Spritzer
- MSK Division, Radiology Department, Duke University Medical Center, Durham, North Carolina
| | - Patrícia Martins E Souza
- Radiology Department, Clinica Radiológica Luiz Felippe Mattoso, Gupo Fleury, Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Dimmick S, Reeve A, Linklater J. Presurgical Perspective and Postsurgical Evaluation of Plantar Plate and Turf Toe. Semin Musculoskelet Radiol 2022; 26:695-709. [PMID: 36791738 DOI: 10.1055/s-0042-1760221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Capsuloligamentous injury of the first metatarsophalangeal (MTP) joint (eponymously called "turf toe") mostly occurs in athletes and involves acute trauma, whereas tears of the lesser MTP joint plantar plate typically are an attritional-degenerative condition. This article reviews the anatomy, pathophysiology, mechanism and patterns of injury, grading and classification of injury, imaging appearances (pre- and postoperative), and management of first MTP joint capsuloligamentous injuries and lesser MTP joint plantar plate tears. These two distinct pathologies are discussed in separate sections.
Collapse
|
3
|
Ultrasound findings of plantar plate tears of the lesser metatarsophalangeal joints. Skeletal Radiol 2021; 50:1513-1525. [PMID: 33423073 DOI: 10.1007/s00256-020-03708-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023]
Abstract
Lesser metatarsophalangeal (MTP) joint plantar plate tears are a common and increasingly recognised cause of metatarsalgia, MTP joint instability and forefoot deformity. Increased interest in early accurate diagnosis of plantar plate tears follows recent surgical innovations allowing direct plantar plate repair. The purpose of this review is to describe the ultrasound features of normal lesser MTP joint plantar plates and to characterise and illustrate the direct and indirect ultrasound findings of plantar plate tears. Lesser MTP joint plantar plate tears are most commonly located at the 2nd MTP joint, involving the lateral distal plantar plate insertion with variable propagation medially and proximally. The most common ultrasound appearance of a plantar plate tear is a discrete partial or full thickness hypoechoic defect in the plate substance. Flattening and attenuation or non-visualisation of the plantar plate represent more extensive tears. Dynamic imaging with toe dorsiflexion improves visualisation of tears and augments MTP joint subluxation. A common indirect finding is pericapsular fibrosis along the MTP joint capsule adjacent to a plantar plate tear, which requires differentiation from Morton's neuroma, and key distinguishing features at ultrasound are described. Other indirect findings include the cartilage interface sign, flexor tendon subluxation onto the metatarsal head or medial to the midline, flexor tenosynovitis, proximal phalangeal enthesophytes or avulsion and MTP joint synovitis. Ultrasound offers several advantages over MR imaging but requires a meticulous ultrasound examination, and optimisation of scanning technique is described.
Collapse
|
4
|
Abstract
Foot and ankle instability can be seen both in acute and chronic settings, and isolating the diagnosis can be difficult. Imaging can contribute to the clinical presentation not only by identifying abnormal morphology of various supporting soft tissue structures but also by providing referring clinicians with a sense of how functionally incompetent those structures are by utilizing weight-bearing images and with comparison to the contralateral side. Loading the affected joint and visualizing changes in alignment provide clinicians with information regarding the severity of the abnormality and, therefore, how it should be managed.
Collapse
Affiliation(s)
- Carolyn M Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| |
Collapse
|
5
|
Meyer NB, Jacobson JA, Kalia V, Kim SM. Musculoskeletal ultrasound: athletic injuries of the lower extremity. Ultrasonography 2018; 37:175-189. [PMID: 29794963 PMCID: PMC6044222 DOI: 10.14366/usg.18013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/14/2018] [Indexed: 12/23/2022] Open
Abstract
Athletic injuries of the lower extremities are commonly encountered in clinical practice. While some pathology can be diagnosed on physical exam, others are a clinical dilemma with nonspecific symptomatology. In these situations, ultrasound imaging can be utilized as an exceptional diagnostic tool, offering unique advantages over other imaging modalities. This article will review the imaging characteristics of commonly encountered athletic injuries of the lower extremity.
Collapse
Affiliation(s)
- Nathaniel B Meyer
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Vivek Kalia
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Sung Moon Kim
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| |
Collapse
|
6
|
Donegan RJ, Stauffer A, Heaslet M, Poliskie M. Comparing Magnetic Resonance Imaging and High-Resolution Dynamic Ultrasonography for Diagnosis of Plantar Plate Pathology: A Case Series. J Foot Ankle Surg 2017; 56:371-374. [PMID: 28231969 DOI: 10.1053/j.jfas.2016.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Indexed: 02/03/2023]
Abstract
Plantar plate pathology has gained noticeable attention in recent years as an etiology of lesser metatarsophalangeal joint pain. The heightened clinical awareness has led to the need for more effective diagnostic imaging accuracy. Numerous reports have established the accuracy of both magnetic resonance imaging and ultrasonography for the diagnosis of plantar plate pathology. However, no conclusions have been made regarding which is the superior imaging modality. The present study reports a case series directly comparing high-resolution dynamic ultrasonography and magnetic resonance imaging. A multicenter retrospective comparison of magnetic resonance imaging versus high-resolution dynamic ultrasonography to evaluate plantar plate pathology with surgical confirmation was conducted. The sensitivity, specificity, and positive and negative predictive values for magnetic resonance imaging were 60%, 100%, 100%, and 33%, respectively. The overall diagnostic accuracy compared with the intraoperative findings was 66%. The sensitivity, specificity, and positive and negative predictive values for high-resolution dynamic ultrasound imaging were 100%, 100%, 100%, and 100%, respectively. The overall diagnostic accuracy compared with the intraoperative findings was 100%. The p value using Fisher's exact test for magnetic resonance imaging and high-resolution dynamic ultrasonography was p = .45, a difference that was not statistically significant. High-resolution dynamic ultrasonography had greater accuracy than magnetic resonance imaging in diagnosing lesser metatarsophalangeal joint plantar plate pathology, although the difference was not statistically significant. The present case series suggests that high-resolution dynamic ultrasonography can be considered an equally accurate imaging modality for plantar plate pathology at a potential cost savings compared with magnetic resonance imaging. Therefore, high-resolution dynamic ultrasonography warrants further investigation in a prospective study.
Collapse
Affiliation(s)
- Ryan J Donegan
- Fellow, Specialty Surgical Center of Irvine Sports Medicine Fellowship, Irvine, CA.
| | - Anthony Stauffer
- Staff Radiologist, West Coast Radiology Santa Ana, Santa Ana, CA
| | | | | |
Collapse
|
7
|
Duan X, Li L, Wei DQ, Liu M, Yu X, Xu Z, Long Y, Xiang Z. Role of magnetic resonance imaging versus ultrasound for detection of plantar plate tear. J Orthop Surg Res 2017; 12:14. [PMID: 28109309 PMCID: PMC5251279 DOI: 10.1186/s13018-016-0507-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/22/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Plantar plate tears could be the reason of forefoot pain, affecting foot function. Magnetic resonance imaging (MRI) and ultrasound (US) were commonly used for the diagnosis of plantar plate tears. The decision of whether to use MRI or US carried some controversy. Our study aimed to find out the diagnostic accuracy of MRI versus US for plantar plate tears. METHODS The database of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and relative orthopedic meetings until May 2016 were searched. Studies involved in the diagnostic detection of MRI or ultrasound for plantar plate tears with surgical criteria as the reference test were included. Data was analyzed by meta-analysis. We compared sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary receiver operating characteristic (sROC) plot of both MRI and US. RESULTS Seven studies involving 246 plantar plate tears were included. The MRI showed more diagnostic accuracy than US for the detection of plantar plate tears. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of MRI were 95%, 54%, 2.08, and 0.08, respectively, while the same values for US were 93%, 33%, 1.20, and 0.35, respectively. And the sROC showed more superior diagnostic accuracy than the US. CONCLUSION The current result suggests that MRI has better accuracy than US for detection of plantar plate tears.
Collapse
Affiliation(s)
- Xin Duan
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Lang Li
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Dai-Qing Wei
- Department of Bone and Joint Surgery, Affiliated Hospital of Westsouth Medical University, #25 Taiping Steeet, Luzhou, Sichuan Province, China
| | - Ming Liu
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Xi Yu
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Zhao Xu
- Anesthesia Department, West China Hospital, Sichuan University, # 37 Guoxuexiang Street, Chengdu, Sichuan province, China
| | - Ye Long
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Zhou Xiang
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China.
| |
Collapse
|