title: Evaluation of lesser metatarsophalangeal joint plantar plate tears with contrast-enhanced and fat-suppressed MRI.
abstract: OBJECTIVE
  To present findings of plantar plate (PP) lesions from MRI with administration of gadolinium and to differentiate PP lesions from others causes of metatarsalgia.
  
  
  METHODS
  Two musculoskeletal radiologists reviewed 249 contrast-enhanced forefoot MRI scans from patients with metatarsalgia between June 2012 and June 2013. Evaluations focused on hyper-vascularized/fibrous tissue and other findings associated with PP tears.
  
  
  RESULTS
  Fifty-nine patients had PP tears, 59 % were female. Most of these patients, 48/59 (81.4 %), had a single metatarsophalangeal (MTP) PP lesion in one foot, although 7/59 patients had one lesion in each foot, 3/59 (5.1 %) had two in one foot, and 1/59 (1.7 %) had three lesions in one foot. The second MTP joint was the most common location for PP tears (n = 56), followed by the third (n = 12) and fourth (n = 3) MTP joints. Lateral (n = 33) and full thickness (n = 28) PP lesions were the most frequent, and central (n = 3) and lateral/central (n = 7) tears were less prevalent. Fifty (70.5 %) PP lesions showed pericapsular fibrosis in pre-contrast sequences, and 21 (29.5 %) were visible only after administration of gadolinium. All PP lesions had collateral ligament involvement. Others findings included interosseous tendon lesions (n = 29), interosseous tendon rupture (n = 29), synovitis (n = 49), flexor tenosynovitis (n = 28), crossover toe (n = 2), hammertoe (n = 1), intermetatarsal space (IS) neuromas (n = 11), and third IS neuromas (n = 12).
  
  
  CONCLUSIONS
  PP tears are a common cause of metatarsalgia, accounting for more than 20 % of cases in our sample. A substantial portion of the lesions (29.5 %) became visible only after the administration of gadolinium.
authors.affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. vanessadinoa@globo.com.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Dinoá
authors.affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: von Ranke
authors.affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Flavia
authors.initials: F
authors.lastname: Costa
authors.affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Edson
authors.initials: E
authors.lastname: Marchiori
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000473:pathology; D008875:Middle Aged; D015588:Observer Variation; D000069262:Plantar Plate / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique
keywords: Magnetic resonance imaging; Metatarsalgia; Metatarsophalangeal joint; Plantar plate