Acute Trauma to the Foot Radiography Foot Metatarsal-Phalangeal Joint Injury The best initial imaging study for evaluating hallux plantar plate disruption after metatarsal-phalangeal (MTP) joint injury is weightbearing AP, lateral, and sesamoid axial views, with addition of comparison radiographs of the contralateral foot [29]. Radiographs may also indirectly evaluate lesser metatarsophalangeal plantar plate injury [30]. The combination of a positive drawer test coupled with transverse deviation of the third MTP joint on radiographs can be used to diagnose high-grade plantar plate tear of the second MTP joint [31]. A forced dorsiflexion lateral view of the hallux MTP joint is recommended if there is clinical suspicion of plantar plate injury of the first MTP joint [29]. Radiography Foot with Weightbearing The best initial imaging study for evaluating hallux plantar plate disruption after MTP joint injury is weightbearing AP, lateral, and sesamoid axial views with addition of comparison radiographs of the contralateral foot [29,32]. MRI Foot MRI is the most sensitive modality for the detection of occult fracture and acute bone stress changes [34,35]. MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the foot in setting of suspected MTP joint injury or occult fracture. Both MRI and US are used in evaluating soft-tissue injuries of the foot in the setting of acute trauma, especially when radiographs are noncontributory. Both modalities have a similar sensitivity for acute soft-tissue trauma about the ankle and foot such as ligamentous and tendinous disruption [36- 38]. US Foot US is not routinely used as the first imaging study for the evaluation of acute trauma to the foot in the setting of suspected MTP joint injury or occult fracture. US has been shown to be sensitive for the diagnosis of acute tendon rupture or tendon dislocation in the foot [36,39,40].
Acute Trauma to the Foot. Acute Trauma to the Foot Radiography Foot Metatarsal-Phalangeal Joint Injury The best initial imaging study for evaluating hallux plantar plate disruption after metatarsal-phalangeal (MTP) joint injury is weightbearing AP, lateral, and sesamoid axial views, with addition of comparison radiographs of the contralateral foot [29]. Radiographs may also indirectly evaluate lesser metatarsophalangeal plantar plate injury [30]. The combination of a positive drawer test coupled with transverse deviation of the third MTP joint on radiographs can be used to diagnose high-grade plantar plate tear of the second MTP joint [31]. A forced dorsiflexion lateral view of the hallux MTP joint is recommended if there is clinical suspicion of plantar plate injury of the first MTP joint [29]. Radiography Foot with Weightbearing The best initial imaging study for evaluating hallux plantar plate disruption after MTP joint injury is weightbearing AP, lateral, and sesamoid axial views with addition of comparison radiographs of the contralateral foot [29,32]. MRI Foot MRI is the most sensitive modality for the detection of occult fracture and acute bone stress changes [34,35]. MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the foot in setting of suspected MTP joint injury or occult fracture. Both MRI and US are used in evaluating soft-tissue injuries of the foot in the setting of acute trauma, especially when radiographs are noncontributory. Both modalities have a similar sensitivity for acute soft-tissue trauma about the ankle and foot such as ligamentous and tendinous disruption [36- 38]. US Foot US is not routinely used as the first imaging study for the evaluation of acute trauma to the foot in the setting of suspected MTP joint injury or occult fracture. US has been shown to be sensitive for the diagnosis of acute tendon rupture or tendon dislocation in the foot [36,39,40].