Stone Michael, Eyler William, Rhodenizer Joshua, van Holsbeeck Marnix
Department of Radiology, Henry Ford Hospital, Detroit, Michigan, USA.
Department of Podiatry, St John Hospital and Medical Center, Detroit, Michigan, USA.
J Ultrasound Med. 2017 Jul;36(7):1355-1361. doi: 10.7863/ultra.16.06067. Epub 2017 Apr 11.
Sonography is often used in the evaluation of forefoot disorders, and its use has been suggested in the diagnosis of plantar plate tears. This study aimed to assess the accuracy of sonography in the diagnosis of plantar plate tears of the lesser digits using gross dissection as the reference standard.
The second through fifth digits of 6 cadavers were examined with sonography to evaluate for plantar plate tears. The examination was performed by a single musculoskeletal radiologist in longitudinal and short axes, and plates were graded as torn or intact. The digits were then dissected by a single podiatrist blinded to the prior sonographic results to assess the integrity of the plates.
Ten plantar plates were graded as torn by sonography, all occurring in the distal plate near the phalangeal insertion. Seven of these plates were identified as torn on direct inspection. Fourteen plantar plates were found to be intact on sonography, 12 of which were intact on gross inspection. Overall, the accuracy, sensitivity, and specificity of sonography were 79.2%, 77.8%, and 80.0%, respectively. No correlation was seen between the accuracy of sonography and plate size, using plate number as a surrogate marker for plate size (P = .822).
Sonography is an appropriate modality in the setting of suspected plantar plate tears, with acceptable accuracy, sensitivity, and specificity. No decline in accuracy was seen with smaller plates. Thus, sonography may be especially useful when small anatomy or technical factors make magnetic resonance imaging challenging to perform and interpret.
超声检查常用于前足疾病的评估，并且有人建议将其用于跖板撕裂的诊断。本研究旨在以大体解剖为参考标准，评估超声检查诊断小趾跖板撕裂的准确性。
对6具尸体的第二至第五趾进行超声检查，以评估跖板撕裂情况。检查由一名肌肉骨骼放射科医生在纵轴和短轴上进行，跖板分为撕裂或完整。然后由一名对先前超声检查结果不知情的足病医生对趾进行解剖，以评估跖板的完整性。
超声检查将10个跖板分级为撕裂，均发生在靠近趾骨插入处的远端跖板。其中7个跖板经直接检查被确定为撕裂。超声检查发现14个跖板完整，其中12个在大体检查时完整。总体而言，超声检查的准确性、敏感性和特异性分别为79.2%、77.8%和80.0%。以跖板编号作为跖板大小的替代标志物，未发现超声检查准确性与跖板大小之间存在相关性（P = 0.822）。
在怀疑跖板撕裂的情况下，超声检查是一种合适的检查方法，具有可接受的准确性、敏感性和特异性。较小的跖板在准确性方面没有下降。因此，当小解剖结构或技术因素使磁共振成像难以进行和解释时，超声检查可能特别有用。
