What can be done about a plantar plate tear?

A plantar plate tear, also known as plantar plate dysfunction or metatarsophalangeal joint instability, is a common foot injury that affects the ligamentous structure located on the underside of the foot. The plantar plate is a thick, fibrous structure that connects the base of the toes to the metatarsal bones (the long bones in the foot) and helps stabilize the metatarsophalangeal (MTP) joints.

When a tear occurs in the plantar plate, it can lead to pain, inflammation, and instability in the affected toe. It is most commonly seen in the second toe, but it can occur in any of the other toes as well. Plantar plate tears often result from repetitive stress or overuse, such as activities that involve running, jumping, or pushing off the toes forcefully.

Common symptoms of a plantar plate tear include:

  1. Pain: There is usually localized pain at the ball of the foot, beneath the affected toe. The pain may worsen during walking, running, or when bearing weight on the foot.
  2. Swelling: The area around the affected joint may become swollen and tender to touch.
  3. Instability: The toe may feel unstable or “loose” due to the weakened or damaged plantar plate. This can cause difficulty with balance and affect your ability to push off the toes while walking or running.
  4. Change in toe alignment: In some cases, a plantar plate tear can cause the affected toe to shift or drift out of its normal alignment, resulting in a hammertoe or crossover toe deformity.

If you suspect a plantar plate tear, it is important to consult a healthcare professional, such as a podiatrist or orthopedic specialist, for an accurate diagnosis. They will typically perform a physical examination of the foot, assess your symptoms, and may order additional imaging tests like X-rays or an MRI to confirm the diagnosis and assess the extent of the injury.

Treatment for a plantar plate tear may include:

  1. Rest and immobilization: Limiting weight-bearing activities and using supportive footwear or a splint to restrict movement and promote healing.
  2. Ice and anti-inflammatory medications: Applying ice packs to the affected area and taking non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation.
  3. Physical therapy: Specific exercises and stretches can be prescribed to strengthen the surrounding muscles, improve stability, and restore normal foot function.
  4. Orthotic devices: Custom-made shoe inserts or pads can provide support, relieve pressure on the affected area, and help correct any underlying biomechanical issues contributing to the injury.
  5. Taping or strapping: Using athletic tape or specialized strapping techniques may offer temporary stability to the affected toe and promote healing. An alternative to taping is the FixToe device.

In severe cases or when conservative measures fail, surgical intervention may be necessary to repair or reconstruct the plantar plate.

It’s important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to your specific condition.

Can a plantar plate injury heal on its own?

This is a question that is often asked and does not have a clear or obvious answer. Everyone is looking for easy and natural ways to treat any condition and a plantar plate injury is no exception. The plantar plate is a strong ligament under the joints in the forefoot that can sometimes get strained due to overuse. Occasionally a small tear develops in that plantar plate ligament.

The typical symptom is pain under the ball of the foot that starts as an ache that gets progressively worse. It is typically much more painful on palpation or poking it. Also the affected toe does tend to be in a more dorsiflexed position.

So, can it heal by itself?

A common treatment (strapping or taping) holds the toe in a plantarflexed position so that it can heal. Is that healing on its own? It could be considered that or is the taping seen as a treatment so that its not healing on its own? Or is this just semantics?

In reality they probably can not heal on there own. They can healing with the strapping and maybe a stiffer soled shoe given time. If those types of treatments do not help, then a surgical repair of the tear in the plantar plate is probably warranted.