Treatment of lesser metatarsophalangeal joint plantar plate tear via Extracorporeal Pulse Activation Technology (EPAT) with MRI Follow-up: A case report

Abstract

Predislocation syndrome has recently gained attention as a common cause of lesser metatarsophalangeal joint (MTPJ) instability, contributing to tenderness, edema, and forefoot pain. The efficacy and utilization of non-operative treatments of plantar plate tears remains controversial; no current studies have conclusively indicated a successful restoration of a plantar plate tear by conservative treatment modalities. Within seven weeks, five total EPAT treatments were administered. Each weekly treatment consisted of 3000 pulses at 2.8 bars, performed directly at MTPJ 2-4 of the affected left forefoot. The patient was monitored on a weekly basis and progress measured utilizing the pain analog scale (0-10), subsequent MRI scans, and a complete return to normal, pre-injury activity. In the final follow-up examination, two months after the first EPAT treatment, the patient reported pain-free ambulation and a complete return to full normal activity. Subsequent MRI scans revealed no evidence of defects with notable improvements in structural integrity to the previously torn plantar plate. The results of this case report demonstrate the potential viability of shockwave therapy for the treatment of plantar plate tears. Further investigation may help to challenge the current standard of care and to provide a better, modern solution to an age-old debate between operative and nonoperative treatments of plantar plate tears