top of page
Search

What is a Plantar Plate Tear and How Can It Be Cured?

A plantar plate tear is a common but often underdiagnosed cause of forefoot pain, particularly under the second metatarsophalangeal (MTP) joint. Here's an overview of how to diagnose and treat it.

🩺 Diagnosis of a Plantar Plate Tear

1. Patient History

  • Symptoms: Pain under the ball of the foot, especially beneath the second toe.

  • Onset: May be gradual or following trauma (e.g., tripping, toe hyperextension).

  • Other signs: A feeling of walking on a stone, swelling, instability in the toe.

2. Physical Examination

  • Dorsal drawer test / Lachman test of the toe: Stabilize the metatarsal head and move the proximal phalanx dorsally; excessive movement or pain is suggestive.

  • Toe alignment:

    • Widening of the space between the toes (often between 2nd and 3rd — "V sign")

    • Possible deviation or dorsal elevation of the toe

  • Tenderness: Direct palpation at the plantar aspect of the MTP joint.

3. Imaging

  • Ultrasound: Effective for visualizing tears in the plantar plate.

  • MRI: Gold standard — shows full vs partial thickness tears, degree of retraction, and any associated pathology.

  • X-rays: May show MTP joint subluxation, especially in chronic or severe cases.

💡 Differential Diagnosis

  • Morton's neuroma

  • Capsulitis

  • Stress fracture of metatarsal

  • Synovitis

  • Metatarsalgia

  • Freiberg’s disease

    plantar plate tear

    ✅ Risk Factors for a Plantar Plate Tear

    A plantar plate tear typically results from chronic overload or mechanical stress at the metatarsophalangeal (MTP) joints, especially the second MTP. Here are the most common risk factors: -

    🔹 Biomechanical Risk Factors

    • Long second metatarsal (Morton’s toe): Increases pressure under the second metatarsophalangeal joint.

    • Equinus deformity (limited ankle dorsiflexion): Leads to forefoot overload during walking.

    • Hypermobility (e.g., Ehlers-Danlos syndrome): Leads to instability and ligament laxity.

    • Hallux valgus (bunions): The first ray becomes less functional, shifting load to the second toe.

    • Pes planus (flat feet): Can contribute to poor forefoot mechanics.

    • Forefoot varus: May lead to abnormal pressure distribution.

    🔹 Footwear Factors

    • High heels: Increase forefoot loading.

    • Flexible-soled shoes: Allow too much MTP joint motion.

    • Poor arch support: Fails to stabilize midfoot and rearfoot mechanics.

    🔹 Activity-Related Risk Factors

    • Repetitive forefoot stress: Activities such as running, dancing, or jumping sports.

    • Sudden trauma: Hyperextension injury of the toe, such as stubbing it or catching it on carpet.

    • Occupational strain: Jobs requiring long periods of standing or walking on hard surfaces.

    🔹 Age and Gender

    • Middle-aged to older adults: Degeneration of soft tissue structures increases risk.

    • Women: More commonly affected, possibly due to footwear choices and higher prevalence of hallux abductovalgus (a bunion).

    🔹 Medical and Systemic Factors

    • Inflammatory arthropathies: Rheumatoid arthritis or lupus can weaken ligaments.

    • Obesity: Increases mechanical load across the forefoot.

    • Diabetes: May alter foot mechanics and delay healing.


      🛠️ Treatment of a Plantar Plate Tear

Conservative Management (for mild or partial tears)

  • Activity modification: Reduce activities that stress the forefoot (e.g., running, jumping).

  • Footwear advice:

    • Use shoes with a stiff sole or rocker-bottom to limit metatarsalphalangeal joint motion.

    • Avoid high heels or flexible-soled shoes.

  • Padding and orthoses:

    • Metatarsal pads to offload pressure from the MTP joint.

    • Custom orthotics with offloading support.

  • Strapping:

    • Tape the toe using 10mm zinc oxide tape to stabilise/immobilise the toe joint

  • Anti-inflammatories: NSAIDs e.g. ibuprofen for pain and to address inflammation.

  • Physiotherapy: To address biomechanics, strengthen the intrinsic muscles, and support foot function.

Injections

  • Corticosteroid injections: Can reduce pain but may risk further weakening of the plantar plate if used repeatedly.

Surgical Treatment

Recommended if:

  • Conservative treatment fails (typically over 3–6 months)

  • Full-thickness tears with significant instability or deformity

Surgical options include:

  • Direct repair of the plantar plate (via dorsal or plantar approach)

  • Weil osteotomy (to shorten the metatarsal and reduce pressure)

  • Soft tissue realignment

  • Occasionally, tendon transfers or toe arthroplasty for chronic or severe deformity


    advanced plantar plate tear

🔁 Recovery and Prognosis

  • Conservative care can be effective in early or partial tears.

  • Surgery typically requires 6–12 weeks of recovery with limited weight-bearing.

  • Delayed treatment increases the risk of joint subluxation and persistent toe deformity (e.g., crossover toe).

📝 Summary

Diagnosis is clinical but supported by imaging. Early recognition and offloading are key to preventing progression. Surgical repair may be needed for full-thickness or chronic tears. A multidisciplinary approach (podiatry, orthopaedics, physiotherapy) yields the best outcomes.



 
 
 

Opmerkingen

bottom of page