The plantar plate is a thick fibrous structure located in the ball of the foot. It is attached to the toe and the head the corresponding metatarsals. The plantar plate plays an important role in keeping the toes in place, stopping them from drifting or over-extending.
Plantar plate injuries are not uncommon and are often associated with toe deformities. The most common cause of this injury is microtrauma due to shearing ground reactive forces leading to a strain of this ligament which then eventually tears completely. Often there are structural abnormalities, such as long 2nd or elevated 1st metatarsal that can predispose patients to develop this injury.
Patients usually notice pain and swelling on the ball of their foot. The toes can also become dislocated at the mpj since there is nothing holding the toe in its anatomic position any more. Pain is described as sharp with ambulation and it is of dull nature during rest. The associated toe deformities can often lead to arthritis of the adjacent bones. Although acute injuries (turf toe) are not uncommon, most often the presentation of symptoms is chronic in nature.
X-rays are taken in the office to assess the deformity. They usually show associated toe deformities that can range from hammer toes to dislocated toes. Structural abnormalities are also identified such as elevated 1st metatarsal or a long 2nd metatarsal. MRI is the gold standard test that confirms the diagnosis.
Conservative treatment includes protected weight-bearing initially to calm soft tissue down along with Rest, Ice, Compression and Elevation. Custom orthotics are also utilized to correct biomechanical abnormalities.
When such measures fail, surgical correction of this injury is considered. This procedure entails identifying the tear surgically and performing a primary repair of the plantar plate. Usually the associated abnormalities are also corrected. This includes shortening osteotomy of the 2nd metatarsal and hammer toe correction of the corresponding digit.
Patients are placed in a CAM boot after the surgery and it takes around 4-6 weeks to ambulate in a regular athletic shoe. Address plantar plate tears is ideal corrected before toes become completing displaced like below. Let one of our surgeons assess your condition and address it before a tear occurs or reconstruct if fully ruptured.