What is a Plantar Plate Tear and What is the Treatment?

 In Lower Limb

Plantar Plate Tear

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 Tweet

The 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)


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