title: How to classify plantar plate injuries: parameters from history and physical examination.
abstract: OBJECTIVE
  To find the best clinical parameters for defining and classifying the degree of plantar plate injuries.
  
  
  METHODS
  Sixty-eight patients (100 metatarsophalangeal joints) were classified in accordance with the Arthroscopic Anatomical Classification for plantar plate injuries and were divided into five groups (0 to IV). Their medical files were reviewed and the incidence of each parameter for the respective group was correlated. These parameters were: use of high heels, sports, acute pain, local edema, Mulder's sign, widening of the interdigital space, pain in the head of the corresponding metatarsal, touching the ground, "drawer test", toe grip and toe deformities (in the sagittal, coronal and transversal planes).
  
  
  RESULTS
  There were no statistically significant associations between the degree of injury and use of high-heel shoes, sports trauma, pain at the head of the metatarsal, Mulder's sign, deformity in pronation or displacement in the transversal and sagittal planes (although their combination, i.e. "cross toe", showed a statistically significant correlation). Positive correlations with the severity of the injuries were found in relation to initial acute pain, progressive widening of the interdigital space, loss of "touching the ground", positive results from the "drawer test" on the metatarsophalangeal joint, diminished grip strength and toe deformity in supination.
  
  
  CONCLUSIONS
  The "drawer test" was seen to be the more reliable and precise tool for classifying the degree of plantar plate injury, followed by "touching the ground" and rotational deformities. It is possible to improve the precision of the diagnosis and the predictions of the anatomical classification for plantar plate injuries through combining the clinical history and data from the physical examination.
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Caio
authors.initials: C
authors.lastname: Nery
authors.affiliation: Saint Alphonsus Foot and Ankle Clinic, Boise, ID, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Coughlin
authors.affiliation: Hospital Felício Rocho, Belo Horizonte, MG, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Baumfeld
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Raduan
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Tania Szejnfeld
authors.initials: TS
authors.lastname: Mann
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Catena
keywords: Acquired foot deformities; Hammer toe syndrome; Metatarsophalangeal joint