nontumoral conditions affecting the hallucal sesamoids; however, it could be useful to distinguish between sesamoiditis and avascular necrosis [32,33]. MRI is widely accepted as the imaging study of choice for diagnosis of plantar plate tears. In a prospective study, Sung et al [40] found high accuracy (96%), sensitivity (95%), specificity (100%), PPV (100%), and NPV (67%) for MRI with surgical correlation. In this study, moderate concordance was found between tear severity on MRI and surgery with greater concordance at higher severity. A meta-analysis showed higher diagnostic accuracy for MRI than US for the detection of plantar plate tears with sensitivity and specificity for MRI of 95% and 54%, respectively [41]. MR arthrography improves visualization of pericapsular structures when compared to conventional MRI and therefore is useful in the diagnosis and characterization of plantar plate tears and abnormalities of related structures [42,43]. US Foot There is limited information available in the literature regarding the use of US in the diagnosis of sesamoiditis. US has been shown to be useful in diagnosing tears of the sesamoid phalangeal ligament in the setting of turf toe [46]. MRI is generally better, but US is also useful in the diagnosis of plantar plate tears. In a cadaveric study, an accuracy, sensitivity, and specificity of 79%, 78%, and 80%, respectively, were found for US [48]. With MRI as the reference standard, Gregg et al [49] showed a sensitivity, specificity, PPV, NPV, and accuracy of 91%, 44%, 93%, 35%, and 85%, respectively, for US in the detection of metatarsophalangeal plantar plate tears in symptomatic subjects. A meta-analysis showed higher diagnostic accuracy for MRI than US for the detection of plantar plate tears. In this meta-analysis the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 93%, 33%, 1.2, and 0.35, respectively, for US [41]. Variant 4: Chronic plantar heel pain. Radiographs negative or equivocal.
Chronic Foot Pain. nontumoral conditions affecting the hallucal sesamoids; however, it could be useful to distinguish between sesamoiditis and avascular necrosis [32,33]. MRI is widely accepted as the imaging study of choice for diagnosis of plantar plate tears. In a prospective study, Sung et al [40] found high accuracy (96%), sensitivity (95%), specificity (100%), PPV (100%), and NPV (67%) for MRI with surgical correlation. In this study, moderate concordance was found between tear severity on MRI and surgery with greater concordance at higher severity. A meta-analysis showed higher diagnostic accuracy for MRI than US for the detection of plantar plate tears with sensitivity and specificity for MRI of 95% and 54%, respectively [41]. MR arthrography improves visualization of pericapsular structures when compared to conventional MRI and therefore is useful in the diagnosis and characterization of plantar plate tears and abnormalities of related structures [42,43]. US Foot There is limited information available in the literature regarding the use of US in the diagnosis of sesamoiditis. US has been shown to be useful in diagnosing tears of the sesamoid phalangeal ligament in the setting of turf toe [46]. MRI is generally better, but US is also useful in the diagnosis of plantar plate tears. In a cadaveric study, an accuracy, sensitivity, and specificity of 79%, 78%, and 80%, respectively, were found for US [48]. With MRI as the reference standard, Gregg et al [49] showed a sensitivity, specificity, PPV, NPV, and accuracy of 91%, 44%, 93%, 35%, and 85%, respectively, for US in the detection of metatarsophalangeal plantar plate tears in symptomatic subjects. A meta-analysis showed higher diagnostic accuracy for MRI than US for the detection of plantar plate tears. In this meta-analysis the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 93%, 33%, 1.2, and 0.35, respectively, for US [41]. Variant 4: Chronic plantar heel pain. Radiographs negative or equivocal.