Rev. Esp. Pod. 2024; 35(1): 57-68 / DOI: 10.20986/revesppod.2024.1693/2024
Javier Alcalá Sanz, Ana Isabel Marcos Casado, Jordi Sánchez Mercè, Bernat Cabestany Perich, Pedro Nogales Gómez
RESUMEN
La placa plantar de las articulaciones metatarsofalángicas menores juega un papel fundamental en la estabilidad digital, manteniendo la correcta alineación del dedo con su metatarsiano y actuando asimismo de punto de anclaje para el resto de estructuras estabilizadoras de dicha articulación. La lesión de este ligamento especializado precipita la deformidad de los dedos menores, en especial el segundo, y es un motivo de consulta habitual en la clínica podológica. En el presente artículo realizamos una revisión pormenorizada de sus características anatómicas e histológicas, sus funciones mecánicas y mecanismos lesionales, así como su exploración clínica y mediante pruebas de imagen, dedicando un apartado especial a la ecografía que se ha erigido en la última década como un recurso accesible y cada vez más habitual en las consultas de podología. Gracias al uso de esta técnica podemos realizar un diagnóstico económico, en tiempo real, dinámico y más preciso del tipo de lesión que se presenta en la placa plantar o en los tejidos adyacentes, desde pequeñas distensiones hasta roturas parciales o completas acompañadas de un mayor o menor daño óseo e inflamación en los tejidos blandos periféricos, como la grasa plantar o los tendones flexores. La caracterización de las lesiones permite correlacionar mucho mejor la etiología con la lesión, así como establecer la mayor o menor necesidad de tratamiento y un pronóstico más certero para cada paciente.
ABSTRACT
The plantar plate of the lesser metatarsophalangeal joints plays a fundamental role in digital stability, maintaining the correct alignment of the finger with its metatarsal and also acting as an achor point of the rest of the articular stabilizing structures. Injury to this specialized ligament precipitates deformity of the lesser toes, especially the second, and is a common reason for consultation in the podiatry clinic. In this article we carry out a detailed review of its anatomical and histological characteristics, its mechanical functions and injury mechanisms as well as its clinical examination and through imaging tests, dedicating a special section to ultrasound, which has emerged in the last decade as a accesible resource and increasingly common in podiatry consultations. Thanks to the use of this technique we can make an economical, real-time, dynamic and more precise diagnosis of the type of injury that occurs in the plantar plate or in the adjacent tissues, from small strains to partial or complete tears accompanied by a greater or less bone damage and infl ammation in peripheral soft tissues such as plantar fat pad or flexor tendons. The characterization of the lesions allows us to correlate the etiology with the lesion much better, as well as establish the greater or lesser need for treatment and a more accurate prognosis for each patient.
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