You're on your feet often throughout the day: at work, school, and physical activity. The constant pressure on the feet puts them at risk for specific injuries, including a plantar plate injury.
The plantar plate is a tough, fibrocartilaginous joint capsule thickening where the proximal phalanx (toe bone) and metatarsal (foot bone) head connect. It's an essential structure that keeps the toes in place and allows you to push off when you walk and run.
However, you can injure or tear the plantar plate, leading to pain, hammertoes, and arthritis, if you don't treat it appropriately.
Dr. Jeffrey E. McAlister is a foot and ankle expert specializing in problems like plantar plate injuries at his practice, Phoenix Foot and Ankle Institute.
Dr. McAlister has extensive experience in conservative and surgical treatments for foot conditions like plantar plate tears. He carefully evaluates each patient and provides cutting-edge treatments for long-term relief.
What is the plantar plate?
The plantar plate is a ligament-like structure that supports the metatarsophalangeal joints of the toes. The MTP joints are where your lesser toe bones connect to the more prominent aspect of the foot.
The stability of the toes is the primary function of the plantar plate. It helps keep the toes in the right place and prevent them from drifting sideways.
However, you can injure the plantar plate, causing it to tear. The leading cause of a plantar plate tear is a strain on the MTP joint.
You can tear the plantar plate from an acute injury, which brings on symptoms quickly. However, most tears develop over time from conditions such as bunions, a longer second toe, or degeneration from osteoarthritis.
Signs of a plantar plate injury
The symptoms of a plantar plate injury vary, depending on the severity of the tear. At first, you may notice slight pain on the bottom of the foot that seems to get worse with activities.
It's common to notice swelling or feel like you’re walking on a marble in the early stages of a plantar plate tear. The symptoms continue to progress without treatment, eventually causing the toe to drift toward the big toe.
As the tear progresses, the affected toe may overlap the next toe, making it difficult to walk and wear shoes. You may even notice an ample space forming between the affected toe and the next toe as it drifts over.
In severe cases of a plantar plate injury, you may develop a hammertoe contracture in the first joint. Once you develop a hammertoe, it's hard to wear shoes because you may not be able to straighten the toe.
How is a plantar plate tear treated?
If you're noticing a problem with the ball of your foot, you should seek treatment as soon as possible. Getting treatment early on helps you avoid painful complications like a hammertoe.
Treatment depends on the severity of the plantar plate injury. Dr. McAlister carefully evaluates your foot to determine the best treatment route for your needs.
In most cases, treatment begins conservatively and progresses to surgery when nonsurgical methods don't work to relieve the problem. Some of the treatments Dr. McAlister recommends include:
With mild-to-moderate plantar plate injuries, resting the toe and applying ice can significantly help the problem. Compression and elevation are also essential components to healing a plantar plate tear.
Taping the toe in place allows the plate to heal and prevents it from drifting sideways and causing instability.
Orthotics are specially designed inserts that fit into your shoes and provide your foot with personalized support. They offer a stiff sole to the shoe, providing necessary support as the plantar plate heals.
Along with other conservative measures, Dr. McAlister recommends you take over-the-counter medications to control inflammation and relieve pain during the early stages of a plantar plate injury.
Plantar plate repair
If other treatments haven't worked, or if you have a severe plantar plate injury, Dr. McAlister may recommend surgery. Typically, basic evaluation is performed in the office and radiographs and most likely an MRI is performed shortly thereafter to confirm a complete tear. A plantar plate repair is a surgical procedure that allows Dr. McAlister to realign the metatarsal bone to take stress off the ball of the foot.
If Dr. McAlister doesn't think the plantar plate is repairable, he may recommend a tendon transfer for relief. He takes a tendon that allows the toe to bend and transfers it to the top of the affected toe, which helps keep the toe down.
You may need several different treatments to alleviate the pain and complications of a plantar plate injury.
Several articles highlight a successful treatment:
The Direct Plantar Plate Repair Technique
Lesser Metatarsophalangeal Plantar Plate Repair
A Guide To Treating Transverse Plane Deformities Of The Lesser Toes
To schedule a consultation with Dr. McAlister, call Phoenix Foot and Ankle Institute today at 602-761-7819, or request an appointment using our online booking tool.