Plantar Plate Tears

What Is the Plantar Plate?

The plantar plate is a soft tissue structure on the bottom of the foot under the metatarsal head. The plantar plate is composed of type 1 collagen and fibrocartilage. The plantar plate attaches to the base of the toe and the metatarsal

What Is the Function of the Plantar Plate?

The plantar plate cushions the bottom of the metatarsal head while walking and running. In addition, the plantar plate helps bring the toe to the floor while standing.

What Are Causes of Plantar Plate Tears?

The following are causes of plantar plate tears:

• A long first metatarsal, short second metatarsal
• Biomechanical abnormalities ie. Bunions, hammer toes, flatfeet
• Arthritis of the big toe
• Cortisone injection into the area
• Excessive use of high heel shoes
• Trauma

What Are the Symptoms of a Plantar Plate Tear?

The following problems can be symptoms of a plantar plate tear:

• Pain in the ball of the foot that has persisted despite changes in shoes and activities
• A second or third toe that appears to be changing position over time
• A diagnosed ‘neuroma’ that has not been responsive to treatment

How Do You Diagnose a Plantar Plate Tear?

The proper diagnosis of a plantar plate tear as well as any underlying foot deformity starts with a physical exam. Your Carolina Foot Specialists doctor will take a thorough history of your foot problem as well as clinical exam and look for:

• Pain at the metatarsal head typically the 2nd metatarsal
• Swelling in the area of the plantar plate
• Instability of the toes
• Hammer toe deformity
• Previous diagnosis of a neuroma

X-Rays

In house X-rays will be ordered of the feet to assess the quality and alignment of the bones of the foot. X-rays are taken to rule out the possibility of fractures or arthritis in the foot.

Magnetic Resonance Imaging (MRI)

If your Carolina Foot Specialists doctor suspects that you might have a plantar plate tear, they may order an MRI. Magnetic resonance imaging is one of the most sensitive imaging techniques for this particular problem. MRI's are one of the best imaging techniques to evaluate the integrity of the plantar plate and to rule out a tear.

Ultrasound

Ultrasound is another diagnostic test that each of our Carolina Foot Specialists locations offer to evaluate the plantar plate and to rule out a neuroma.

Non-Surgical Treatment Options

Non-surgical treatment options for this pathology are initiated to help alleviate any discomfort in the foot. They include:

• Rest
• Ice
• Anti-inflammatory medication
• Offloading metatarsal padding.
• Cross over taping of the digit to take pressure of the joint
• Custom foot orthotics to accomodate for a biomechanical issue with the feet.
• Changes in Shoes: Avoiding shoes that aggravate this problem (high heels and tight shoes)

When Is Surgical Treatment Necessary?

Surgical treatment is suggested when non-surgical measures fail to alleviate pain and begin to limit your lifestyle.
Surgically this problem is addressed by a direct repair of the plantar plate via a dorsal or plantar incisonal approach, metatarsal osteotomy, and repair of a deviated digit (hammer toe repair).

Aggressive physical therapy and close follow up after surgery are the goals that Carolina Foot Specialists employs to return to activity as quickly as possible after surgery if needed.