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“Another clinical examination technique to diagnose plantar plate tears which I developed about 7 years ago is the Distal Digit Level Test. This is performed by the clinician manually loading the plantar metatarsal heads with the dorsal aspect of their fingers in order to assess the alignment of all the distal digits relative to each other.
The Distal Digit Level Test will dorsiflex the forefoot on the rearfoot which, in turn, causes the plantar fascia (and intact plantar plates) to plantarflex all the digits. If a significant plantar plate tear is present, the affected digit will not plantarflex as much as the unaffected digits during the Distal Digit Level Test so that the affected digit will be more dorsiflexed at the MPJ than the unaffected digits. Since a plantar plate tear causes a relative lengthening of the strip of plantar fascia attaching to the base of the digital proximal phalanx, the Distal Digit Level Test will not produce normal digital plantarflexion which may also cause a reduction of digital purchase in standing and other weightbearing activities.”
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