Plantar Plate Tear, Symptoms and Treatment

 

Plantar Plate Overview

Plantar plate is soft tissue structure made of collagen / fibrocartilage  located on under the metatarsal heads.  The plantar plate spans between the base of the toe and the head of the metatarsals.  The plantar plate is attached to the base of the phalanx and the head of the metatarsals by a very thin ligament.

What Are Causes of Plantar Plate Tears?

The following can be the cause of plantar plate tear:

  • A long 2nd metatarsal
  • A short 1st metatarsal
  • A short third metatarsal
  • Elevated 1st metatarsal
  • Biomechanical abnormalities that causes overload of the metatarsal heads
  • Limited motion of the big toe
  • Cortisone injection into joint or around the area

 

What Are the Symptoms of a Plantar Plate Tear?

The following can be symptoms of a plantar plate tear:

  • Persistent pain and swelling in the ball of the foot
  • Second or third toe that appears to be changing position over time (going towards the adjacent toes)
  • A diagnosed ‘neuroma’ that has not been responsive to treatment
  • Pain under the metatarsal head
  • Swelling under the metatarsal head (ball of foot)
  • Toe joint (metatarsophalangeal joint) Instability
  • Limited motion to the big toe joint
  • Hammertoe / Crossover toe
  • Sign and symptoms of Neuroma

 

Imaging for Plantar Plate Tear:

  • X-ray
  • Magnetic resonance imaging (MRI)
  • Ultrasound
  • Arthrogram (Fast result, Inexpensive and Highly Accurate)

 

Non-Surgical Treatment Options for Plantar Plate Tear:

Non-surgical treatment options for plantar plate tear include:

  • Rest
  • Ice
  • Anti-inflammatory medication (i.e. Ibuprofen)
  • Orthotics with metatarsal cookie (to reduce pressure on the joint) Abductor hallucis muscle strain
  • Topical pain relieving gel Abductor hallucis muscle strain

 

When Is Surgical Treatment Necessary?

Surgical treatment is suggested when non-surgical measures fail to alleviate symptoms / pain