Diagnóstico por imagem na instabilidade metatarsofalângica

Can ultrasound of plantar plate have normal appearance with a positive drawer test?

“…Nearly 25% of all load on the forefoot is centered on the second toe, because, due to its length, it is part of the two axes of strength and balance of the forefoot during the propulsion phase of walking [3,19]. Changes in the load pattern of the forefoot, which can be caused by hypermobility of the first radius, or by hallux valgus, can increase the load on the second toe.…”

“…Increased load may in turn predispose to acute synovitis, leading to capsular distension and PP lesions. Hallux deviation may also be associated with the forces that determine the hyperextension of the second MTP joint, resulting in the loss of intrinsic muscle stability [3]. The high incidence of second MTP joint instability may also be attributed, in part, to the long-term use of high-fashion footwear in the older female population.…”

“…These plates are firmly adhered to the proximal phalanx by collagen fibers that do not penetrate the hyaline cartilage, and run directly into the bone [2] but are only loosely inserted into the lower portion of the metatarsal neck by synovial connections. Additionally, MTP-PPs are predominantly composed of type-I collagen, represent the larger structure of distal fixation of plantar aponeurosis, and are connected to transverse intermetatarsal ligaments and accessory collateral ligaments of MTP joints [3,4]. MTP-PP ruptures may be related to acute traumatic events or sub-acute repetitive traumas (degenerative lesions) [5,6].…”