Sonography of Plantar Plates in Cadavers: Correlation with MRI and Histology
Julie M. Gregg1,2,
Morry Silberstein2,
Timothy Schneider3,
Jeffrey B. Kerr4 and
Paul Marks1,2
1 Department of Diagnostic Imaging, Symbion Healthcare, The Avenue Hospital, 40
The Avenue, Windsor, Victoria 3181, Australia.
2 Department of Medicine, Monash University, Clayton, Victoria, Australia.
3 Melbourne Orthopaedic Group, Windsor, Victoria, Australia.
4 Department of Anatomy and Cell Biology, Monash University, Clayton, Victoria,
Australia.
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Fig. 1A —Sonograms of normal plantar plate in 19-year-old fresh cadaver.
Longitudinal image of third plantar plate of right foot shows mildly echoic
plantar plate (short arrows) is homogeneous and lies deep in relation
to flexor tendon (arrowhead). Plantar plate is superficial to
metatarsal head and hypoechoic line of hyaline cartilage (long
arrows) inserting onto proximal phalanx (asterisk).
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Fig. 1B —Sonograms of normal plantar plate in 19-year-old fresh cadaver. In
transverse image of second plantar plate of left foot at level of metatarsal
head, calipers delineate width of homogeneous plantar plate (arrows),
which is seen lying superficial to metatarsal head and deep in relation to
rounded flexor tendon (asterisk). Thin hypoechoic hyaline cartilage
(arrowheads) is seen against bright line of skeletal cortex.
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Fig. 2A —74-year-old male soft-embalmed cadaver with full-thickness tear of
second plantar plate of left foot. Sagittal proton density–weighted
image lateral to flexor tendon has been rotated to correspond directly to
sonogram in Figs. 1A and
1B (plantar surface is at top).
Low-signal-intensity fibers of fifth plantar plate are seen to insert onto
proximal phalanx (arrow), contrasting with increased signal intensity
of articular cartilage (arrowheads).
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Fig. 2B —74-year-old male soft-embalmed cadaver with full-thickness tear of
second plantar plate of left foot. Coronal proton density–weighted image
shows normal plantar plate (white arrows) to be C-shaped band of low
signal intensity. On plantar surface, central groove accommodates flexor
tendon (arrowhead). Collateral ligaments (asterisks) blend
with plantar plate. Incidentally, intermetatarsal fibrosis is seen in first
and third web spaces (black arrows) and fibrosis is also present in
fat pad directly beneath second and third metatarsal heads.
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Fig. 2C —74-year-old male soft-embalmed cadaver with full-thickness tear of
second plantar plate of left foot. Coronal T2-weighted fat-suppressed image of
normal plantar plate shows thin band of hyaline cartilage as high signal
intensity on articular surface (arrowheads). Low-signal-intensity
circular flexor tendon abuts plantar surface of plantar plate (arrow)
centrally.
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Fig. 2D —74-year-old male soft-embalmed cadaver with full-thickness tear of
second plantar plate of left foot. Sagittal proton density–weighted
image of second plantar plate shows hyperintense focus (arrow) that
replaces normal hypointense fibrocartilage of plantar plate. Arrowhead
indicates intact plantar plate.
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Fig. 2E —74-year-old male soft-embalmed cadaver with full-thickness tear of
second plantar plate of left foot. Coronal T2-weighted fat-suppressed image at
level of insertion of second and third plantar plates onto proximal phalanx.
Ill-defined focus of increased signal intensity represents plantar plate tear
(white arrow). Normal plantar plate fibers are seen laterally.
Plantar plate tear is also seen in third plantar plate (arrowhead).
Adventitial bursitis is seen as hyperintense regions in fat pad adjacent to
second through fourth metatarsal heads (black arrows).
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Fig. 2F —74-year-old male soft-embalmed cadaver with full-thickness tear of
second plantar plate of left foot. Corresponding axial proton
density–weighted image shows plantar plate disruption (white
arrow) located centrally. Lateral collateral ligaments (black
arrow) remain intact.
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Fig. 2G —74-year-old male soft-embalmed cadaver with full-thickness tear of
second plantar plate of left foot. Sagittal paraffin section shows dense
fibrocartilage is disrupted proximal to its insertion onto proximal phalanx.
This results in abrupt border between fibrocartilage (white arrows)
and replacement cellular structures, including vacuoles (asterisks)
and vessels (black arrows). Remnant fibrocartilage inserts into bone
(B). (Masson's trichrome stain, x5)
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Fig. 3A —Photomicrographs of histopathology specimens from plantar plate of
right foot in 19-year-old fresh cadaver. Sagittal paraffin section of third
plantar plate shows densely interwoven connective fibers (long
arrows) and dense connective septa (arrowheads). Hyaline
cartilage (small arrow) undercuts plantar plate at insertion.
Tidemark (asterisk) represents interdigitations between calcified
fibrocartilage and subchondral bone. B indicates bone. (Masson's trichrome
stain, x5 magnification)
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Fig. 3B —Photomicrographs of histopathology specimens from plantar plate of
right foot in 19-year-old fresh cadaver. Fibrocartilage (F) of plantar plate
is tightly compacted with collagen, with intermittent connective tissue septa
(black arrows) and blood vessels (white arrow). (Masson's
trichrome stain, x33 magnification)
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Fig. 4 —92-year-old female soft-embalmed cadaver, third plantar plate of
left foot. Longitudinal sonogram of plantar plate shows partial tear
represented as hypoechoic change (white arrows) extending from
articular surface to very near plantar surface. Normal plantar plate fibers
are seen proximally (arrowhead) and at insertion (black
arrow), where a flap of remnant tissue is visible.
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Fig. 5A —74-year-old male soft-embalmed cadaver, second plantar plate of left
foot. Sonogram shows full-thickness tear (white arrows) of
insertional fibers of plantar plate represented as hypoechoic defect extending
from articular surface to plantar surface. Remaining plantar plate
(arrowhead) is homogeneous. Flexor tendon (black arrow) is
seen overlying plantar plate.
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Fig. 5B —74-year-old male soft-embalmed cadaver, second plantar plate of left
foot. Transverse sonogram shows torn plantar plate. Calipers delineate
location and width of tear, which is centrolateral and hypoechoic (white
arrow) to normal plantar plate tissue seen medially. Flexor tendon
(black arrow) remains centrally located, and some subcutaneous fluid
(arrowhead) is present adjacent to flexor tendon.
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Fig. 6 —92-year-old female soft-embalmed cadaver. Sagittal proton
density–weighted MR image of third plantar plate of left foot shows
replacement of normal plantar plate fibers with a hyperintense focus (long
arrow) on articular surface. Thin section of low-signal-intensity plantar
plate persists on plantar surface, suggestive of partial-thickness tear of
plantar plate. Short arrow indicates intact plantar plate fibers. Arrowhead
indicates proximal plantar plate, which is completely intact.
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Copyright © 2006 by the American Roentgen Ray Society.
