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Plantar Plate Tear

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What Is A Plantar Plate Tear?
Causes And Risk Factors
Symptoms
Diagnosis
Treatment
If You Ignore A Plantar Plate Injury

Plantar plate tears cause pain at the ball of the foot that can make it difficult to bear weight on the feet, especially when bending the toes upwards. Sometimes, as a result of a longstanding plantar plate tear, the space next to the affected toe may increase to leave a ‘V’ appearance between the toes.

What Is A Plantar Plate Tear?

The plantar plate is a thick, fibrous tissue at the bottom of the foot that starts within each joint at the ball of the foot and extends up through the joint capsule and into the toes. Due to its location, pressure is placed on it with every step you take. When the plantar plate is overloaded and damaged, a plantar plate injury or a more serious plantar plate tear can occur.

Plantar plate injuries are serious because plantar plates have many important functions. They are responsible for helping maintain the stability and alignment (and hence function) of the toes, helping prevent them from spreading or splaying, helping you push off the ground when walking, and preventing your toes from hyperextending when they’re bent upwards. This means that when the plantar plate is damaged and torn, toes can move out of alignment and your gait can change significantly - and often detrimentally. 

Causes And Risk Factors

Plantar plate injuries and tears occur when the forefoot, and hence the plantar plate, is overloaded with excess pressure or force placed on the tissue. This overloading may occur from:

• Activities that load up the forefoot, including skipping, running and dancing
  
• Foot biomechanics that lead to excess pressure at the forefoot, such as a flatter foot posture
  
• A job or activity where you’re regularly climbing stairs
  
• Wearing shoes that regularly overload your forefoot, such as high heels
  
• Having bunions, hammertoes or clawed toes
  
• Walking for prolonged periods on hard surfaces like concrete, or in hard, unsupportive footwear
  
• Having a longer second toe, or a shorter big toe, may also make you more vulnerable to plantar plate injuries
  

Symptoms

The second toe joint is the most common place for a plantar plate injury to occur, although any toe can be affected. If you’ve injured your plantar plate, you may:

• Feel like you’re walking directly on the bones at the ball of the affected foot
  
• Experience pain and swelling at the affected toe joint, which can occur both at the bottom of the joint and above it
  
• Have exacerbated pain when the toe is pushed upwards, either manually or when walking 
  
• Notice a ‘V’ sign between the affected toe and the one next to it, indicating the joint may not be stable or aligned and so the toes are drifting apart from one another 
  

Diagnosis

Plantar plate tears can be confidently diagnosed by our podiatrists in our clinic during a physical assessment and thorough exam. Depending on how the injury is likely to have arisen, if we suspect that other structures have been involved in the injury, we may refer you for medical imaging to get the complete picture of the extent of your injury, so we can prescribe the best course of treatment.

Treatment

We find that the earlier we are able to diagnose and start treating your plantar plate injury, the better and faster we can get you back to moving without pain. Treating a plantar plate injury comes in two stages, the first being relieving your pain and symptoms so you can walk more comfortably, and the second is supporting the healing and repair of the plantar plate while putting the right measures in place to prevent it from recurring in the future. To achieve this, we may use:

• Strapping: we may use a technique called digital plantarflexion taping to help in the early stages of your treatment, which will help keep the affected joint stable in a neutral position that prevents it from hyperextending upwards, which may further disrupt the plantar plate. With the movement of the joint limited, you are likely to experience less pain, and the inflammation can reduce.

• Padding: another temporary option like strapping above, we may use padding for a short time to help alleviate pressure away from the injured joint to reduce pain and support recovery.

• Custom foot orthotics: where the cause of your plantar plate injury is linked to your foot biomechanics, custom foot orthotics can be prescribed to optimise the position and function of the foot, alleviating the excess pressure from the ball of the foot with each step. This also helps prevent your injury from recurring in the future.

• Shockwave treatment: depending on your symptoms, we may use shockwave treatment to accelerate the healing of your plantar plate, helping you return to pain-free living faster.

• Footwear assessment: your shoes should be supporting your recovery and not adding to your symptoms, so we’ll assess your shoes to make sure this is the case, and if needed, recommend better shoe options to wear throughout your recovery. 

• Footwear modifications: depending on your symptoms, certain footwear modifications may help optimise your comfort and support your recovery, such as offloading the plantar plate with an aperture in the shoe or adding a soft layer made of poron or plastazote to the shoe.

• In-shoe pressure analysis: we may also perform an in-shoe pressure analysis to understand how your feet and shoes are working together and the resulting pressure on the ball of your foot, using this key information to optimise your treatment.

• Laser treatment: if indicated, we may use laser as a safe and painless way to reduce your inflammation and accelerate the healing and repair of your plantar plate.

• Splinting or moon boot: in a few severe cases, a splint or boot may be required to offload the forefoot completely.
  

If You Ignore A Plantar Plate Injury

If a plantar plate injury or tear is not effectively rehabilitated, the condition can become chronic. This means you may develop long standing toe deformities, which can erode the joint capsule, put you at risk of developing arthritis in the joint, and lead to pain, stiffness and impaired function. The toe may also dislocate out of place, affecting your foot biomechanics and gait, even to the point where you may need to consider a surgical correction.