[Plantar plate and second ray syndrome: Normal and pathological US imaging features and proposed US classification]

Area of Science:

• Orthopedics
• Diagnostic Imaging
• Podiatry

Background:

• Second ray syndrome involves degenerative changes in the plantar plate, often linked to hallux valgus.
• These conditions can necessitate specific surgical interventions for effective treatment.
• Accurate diagnosis is crucial for planning appropriate surgical correction.

Purpose of the Study:

• To propose an ultrasound (US) classification for second ray syndrome associated with hallux valgus.
• To assess the impact of this US classification on patient management and surgical planning.
• To evaluate the utility of US in identifying plantar plate lesions not evident on routine imaging.

Main Methods:

• A total of 52 patients with hallux valgus and metatarsal pain, scheduled for surgery, underwent ultrasound imaging.
• Ultrasound findings were correlated with clinical presentation and surgical plans.
• Changes in treatment plans based on US findings were recorded.

Main Results:

• Ultrasound imaging led to a modification of the treatment plan in 32% of the evaluated patients.
• Plantar plate lesions, previously unsuspected based on clinical examination and routine imaging, were identified by US.
• These US-detected lesions directly influenced the surgical procedure in a significant portion of cases.

Conclusions:

• Ultrasound imaging is a valuable tool for assessing second ray syndrome in patients with hallux valgus.
• The proposed US classification aids in identifying critical plantar plate abnormalities.
• US improves surgical management by providing crucial diagnostic information, leading to more tailored treatment strategies.