What is a Plantar Plate Tear and What is the Treatment?
A plantar plate tear is a common injury of the forefoot which is caused by repetitive overload. The plantar plate is a ligament that is situated on the underside of the metatarsal phalangeal joints at the ball of the feet.
A plantar plate tear is a common injury of the forefoot which is caused by repetitive overload. #performbetter @pogophysio Click To TweetThe most common site is a tear of the second metatarsal phalangeal joint plantar plate. This is because the second metatarsal is often the longest of the metatarsals and therefore bares full force during the propulsion phases of walking and running.
The reasons for the overload can be due to the individual’s anatomy (e.g. short first metatarsal or a long second metatarsal), over pronation (rolling in), hypermobile joints and in-correct casual and/or running shoes.
There can be swelling present and tenderness is typically underneath the joint. A claw toe deformity may or may not be present. If there is a significant deformity then a possible complete rupture should be considered. A special test called the modified Lachman’s test can be performed by your practitioner to test the plantar plate integrity.
Investigation of the area via an ultrasound or MRI is important to determine the extent of a potential tear especially if there is significant pain and/or a claw toe deformity present. Consideration for a clear diagnoses is also important to aid in deciding whether a surgical opinion is needed failing conservative treatment. It can also help differentiate a plantar plate tear from other less serious conditions such as a capsulitis or synovitis of the metatarsal-phalangeal joints.
Treatment involves offloading the area using padding, stiff-soled shoes and if present reducing any claw toe deformity using a taping technique called ribbon taping. Icing, Non-steroidal anti-inflammatory drugs and active rest is also indicated to help settle the condition down. Correction of excessive pronation using an orthotic device can used once a positive result has been obtained using functional foot taping. A metatarsal pad is added onto the device as well to deflect pressure away from the affected area and to improve loading patterns.
If you have further questions please contact me.
Aleks Baruksopulo
SportsMed Podiatrist
BSc (Biomed), BHlthSc (Pod)
Featured in the Top 50 Physical Therapy Blog
Hi, I have just been considered for this injury by my physic, I will need to have a scan. The swelling is around the 2nd & 3rd toe, I have a really bad bunion that foot already. I currently play two game of hockey a week. is there anything I can do to help it?
Hi,
My name is Aleks Baruksopulo and I am the author of the blog where you posted your question about what you can do if you are diagnosed as having a plantar plate tear.
First of all it is great that you are seeking a clear diagnosis via imaging. There are a few differential diagnoses in this area and it is important that the pathology and the extent of the pathology is clearly identified. It can be a tricky area to image and it is important that the images are ordered correctly (if ordering an MRI) and read by an experienced musculoskeletal radiologist preferably specialising in the foot.
If you are diagnosed with a plantar plate tear then common treatment includes wearing a stiff soled running shoe as often, ribbon taping, metatarsal bar padding inside your shoes and eventually a soft form EVA orthotic device incorporating a metatarsal bar. Sometimes we can use a carbon fibre plate to further stiffen inside of joggers and other sports shoes if there is enough room. A sports experienced Podiatrist will be able to show you how to do the aforementioned and provide you with the suitable orthotic device and plate.
As you could imagine it is a little difficult giving you immediate advice without seeing your foot and assessing your situation in regards to your hockey/activity/occupation. Safe immediate advice if you have not been doing already is to wear a stiff soled shoe and/or your joggers as often, ice your forefoot as often and manage load with advice from your physio.
I hope this has been helpful and please let me know if you have any further questions and I wish you the best with your foot.
Kind Regards,
Aleks
Hi Elizabeth,
My pleasure. I am actually on the Gold Coast….. still not in Sydney though!
Don’t worry you haven’t wasted your time re xray. A weight bearing x-ray is normal procedure and can be useful to have a look at what is called the metatarsal formula. If for example the 2nd metatarsal bone is significantly longer than the 1st metatarsal bone then this can be the mechanism or contributing factor to the problem. This combined with flat feet or more importantly excessive pronation (rolling in of your feet) while you are running/playing hockey this can be a further overload the area because you are placing more weight unevenly through the medial (inside) side of your forefoot when you are pushing forward.
Yes I would be trying the orthotics inside your hockey boots. If they do not fit or are uncomfortable make sure to take back to your Podiatrist to adjust/re-do.
Keep me updated and if you are at wits end with it feel free to give me a call to talk about it. One thing I do enjoy about what I do is trying to give athletes/runners as much clarity about what is required to get better as well as who to see and when especially if things are not going to plan.
Have a great weekend.
Regards,
Aleks
Hi. I am a professional dancer and I was diagnosed with this injury in early July. I had an MRI done and was told I have a partial plantar plate tear under my second metatarsal. It is already almost seven weeks since I first injured my foot and while the pain with walking is minimal, I’m still in a lot of pain whenever I go on the ball of my foot, which is obviously a huge part of my dance career. How long does this injury usually take to heal and what do you advise doing to make it heal faster?
Thank you,
Anna
Thanks for your query Anna.
Aleks our podiatrist will reply in full shortly.
Regards Brad Beer
Hi Anna. Thank you for making contact and that is no good regarding the plantar plate tear. I do see a fair few of these right through to full ruptures. As you could appreciate without assessing your foot, getting a clear history and knowing exactly what has been put in place for you in terms of treatment it can be difficult to provide advice for exactly your situation. In saying that a plantar plate injury/tear can be a fiddly area to heal mainly because of this area being highly exposed to pressure even just walking around. Not to mention up on your forefoot dancing. Healing time will depend on the size of the tear and how well you can protect it but as a rough guide it usually takes 8 to 12 weeks. If the tear is not healing despite all conservative measures to offload and protect it (a good Podiatrist will be able to provide this for you) then potentially seeking further advice from a sports physician who can also use treatments like plate rich plasma injections to help with the healing. They also often work alongside orthopaedic surgeons and will know if you require a surgical review in the worse case scenario if it is still not healing. I hope this helps and please feel free to further reach out to me if you have any further questions. Wishing you a speedy recovery and have a good rest of the week. Kind Regards, Aleks. e: aleks@sportsmedpodiatry.com.au. m: 0412969893
Hi. Thanks so much for your article.
This past Dec I significantly injured my plantar plate near the base of the left 2nd mp joint. I fell going UP the stairs and folded my foot in half under my body weight-while wearing stiff trail shoes. Injury was 9 weeks ago and I currently have mostly the same level of pain and restriction as the day of injury. I’ve seen two physicians-the latter being a podiatrist. He took weight bearing X-rays and gave me a post op shoe (which I wore twice). Finally found alternative and more comfortable shoe options to serve the same purpose.
I have two questions. 1. Is there a taping technique video you recommend? He did not recommend one. And a carbon insole? I have pain near the base of my toes when lifting my heel to step forward.
And 2. Should I seek a sports podiatrist?
I’m in southwest MO and will gladly travel to receive appropriate treatment. I am very active and this injury has set me back over 2 months and counting. So far I see no relief in sight. For cardio, I am able to use the elliptical for about 15 min at a time before the pressure is too great. Fortunately I can still do some weight lifting, although still modifying. I splint my 2nd toe at all times but when I remove the splint, the toe almost immediately crosses the 3rd toe.
Originally I was dreading an operation. I already have a plate and 2 screws in my foot from a prev bunionectomy, I have also damaged my posterior tibialis tendon while running. Twice. But at this point I really just want to expedite the healing process, even if surgery is necessary. Any advice is appreciated!
Thanks so much in advance for your help!
Hi Kimberley,
Thank you for your query.
Re your queries:
1. taping technique for planar plate injuries (stops digit dorsi flexing past 10-15degrees and quite simple to do) : click HERE>>
2. re seeing a sports podiatrist-yes. Alternately consult with a reputable foot and ankle surgeon for a thorough assessment and management plan.
I hope this helps.
Keep me posted of the journey.
Brad Beer
Sports & Exercise Physiotherapist
Brad Beer
APA Sports & Exercise Physiotherapist
Hi Aleks,
2 years ago, I had a plantar plate tear op, where screws were inserted in my foot.
I am now almost in as much pain as before the surgery.
My question is can the screws be removed & will I go back to the way I was before?
Regards
Chris Mitchell
Hi Chris,
Thank you for your query.
In such an instance it depends.
I suggest returning to your orthopaedic surgeon for their advice and assessment of your current situation.
Out of interest what type of surgery did you originally have done?
A flexor-to-extensor tendon transfer?
Regards Brad Beer
Sport & Exercise Physio