Magnetic resonance imaging (MRI) is useful for diagnosing plantar plate tears but may not reliably rule out tears. A prospective study of 41 patients underwent MRI of the foot before surgery for suspected plantar plate pathology. MRI correctly identified 39 of 41 tears but missed 2 tears, giving it a sensitivity of 95% and specificity of 100%. MRI appears good for confirming a tear but may miss some, with a negative predictive value of 67%. MRI can help clinicians diagnose plantar plate tears but ultrasound may also be useful to evaluate.