title: Clinical examination of plantar plate abnormality: a diagnostic perspective.
abstract: BACKGROUND
  Plantar plate tears can cause pain and deformity in the forefoot but are frequently missed on initial examination. The purpose of this article was to evaluate the diagnostic statistics of common clinical examination parameters using observed intraoperative abnormality as the referenced standard.
  
  
  METHODS
  Medical records of 90 patients (109 feet) who underwent a plantar plate repair were reviewed for the presence and onset of pain, plantar edema, instability of the second metatarsophalangeal (MTP) joint (drawer sign), pain with range of motion of the lesser MTP joint, first MTP joint range of motion, crossover toes, previous first ray surgery, and previous corticosteroid injections. Clinical examination findings were compared with intraoperative findings. Diagnostic statistics were calculated.
  
  
  RESULTS
  Parameters with a high sensitivity (greater than 80%) were gradual onset of pain (93%), previous first ray surgery (100%), pain at the second metatarsal head (98%), edema at the second metatarsal head (95.8%), and a positive drawer sign (80.6%). High specificity (greater than 80%) was found for a positive drawer test (99.8%) and crossover toes (88.9%). Parameters with odds ratios greater than 1 were gradual onset of pain (1.104), pain at the second metatarsal head (6.125), edema at the second metatarsal head (2.875), and a positive drawer sign (1.389).
  
  
  CONCLUSIONS
  Ninety-five percent of patients with a plantar plate tear presented with a gradual onset of forefoot pain, edema, and a positive drawer sign. A comprehensive clinical examination can heighten the suspicion for plantar plate tears when the data are interpreted correctly.
  
  
  METHODS
  Level III, retrospective, diagnostic.
authors.affiliation: Weil Foot and Ankle Institute, Des Plaines, IL 60016, USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Klein
authors.forename: Lowell
authors.initials: L
authors.lastname: Weil
authors.forename: Lowell Scott
authors.initials: LS
authors.lastname: Weil
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Coughlin
authors.forename: Jessica
authors.initials: J
authors.lastname: Knight
mesh_terms: D004487:Edema / Q000209:etiology; D005530:Foot Deformities / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008487:Medical History Taking; D008683:Metatarsophalangeal Joint / Q000503:physiopathology; D016017:Odds Ratio; D010146:Pain / Q000209:etiology; D053401:Palmar Plate / Q000293:injuries* / Q000601:surgery; D010808:Physical Examination; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: plantar plate repair; plantar plate tear; second MTP joint instability