Understanding Plantar Plate Injury
Plantar plate injury is one of the most common causes of pain in the ball of the foot, though it may be a condition that is not widely recognized by the public.
What is plantar plate?
The plantar plate is a thick fibrocartilaginous or ligamentous structure of the joint capsule under the ball of the foot. It connects each of the metatarsals to the corresponding proximal phalanges of each toe. It serves to stabilize the metatarsophalangeal (MTP) joints, protect the head of the metatarsal from pressure and prevent over extension or dorsiflexion of our toe joints. Injuries of the plantar plates include partial tears through to complete rupture.
How does it feel?
Plantar plate injuries cause persistent pain and under the ball of the foot which can extend towards the toes. Such condition typically affected the 2nd toe and generally get worse with prolonged weight-bearing. It may feel as though there is no enough cushion between the bone and the ground. Swelling may be present under or on top of the forefoot. Such swelling can sometimes cause impingement of the surrounding nerves, resulting in a numb sensation in the forefoot.
The joint may appear dorsiflexed/clawed and splayed/deviated in relaxed standing and additional dorsiflexion may aggravate the pain further. Plantar plate injury is sometimes referred to as predislocation syndrome. As the condition progress, this condition can lead to subluxation or dislocation of the affected joint.
Other conditions that also causes the ball of the foot pain and similar symptoms with plantar plate injuries include morton neuroma and sesamoiditis. Capsulitis is a similar condition that can be a precursor to plantar plate tear.
What causes plantar plate injury or tear?
Although plantar plate tears can occur acutely through a direct stubbing injury that causes disruption to this structure, they’re most commonly develop slowly over time from a progressive degeneration of the ligament from repetitive overuse or abnormalities.
Biomechanical abnormalities. Plantar plate tears usually result from repetitive overload from abnormal forefoot loading patterns resulting from excessive pronation, and the comparatively long length of the second metatarsal / short or elevated first metatarsal.
Foot deformities such as bunions and hammer toes. Bunion or hallux valgus deformity can cause abnormal forefoot loading patterns, contributing to a repetitive type injury to the plantar plate of the second toe. The large bunion that pushes on the second toe can eventually under-lap the toe, causing it to dislocate.
Certain footwear such as high-heeled shoes can increase vertical peak pressures under the second toe, similar to similar repetitive forefoot loading as described above.
What is the treatment for plantar plate injury or tear?
The conservative treatment depends on the stage of the plantar plate injuries. In general, the first line of approach will be to provide symptoms relief and prevent progression of the condition and subsequent dislocation. These include rest, review of activity, change in footwear - avoidance of high-heeled shoes and use of anti-inflammatory agents.
In conjunction to symptoms relief, the root cause of the condition (eg. biomechanical abnormalities and foot deformities) should be identified and addressed. The abnormal repetitive pressure through the forefoot can be addressed through strapping of the toe, use of offloading padding, footwear modification and orthotic therapy. If you have any calluses that maybe aggravating the discomfort, such calluses will also be addressed.
Treatment for this condition can take 3-4 months depending on the severity of the condition and the load bearing nature of the structures involves. Occasionally surgery may be indicated to repair the plantar plate if conservative management are not effective. It is important to note that such condition occurs gradually and it is best treated in the early stages.
How can I prevent plantar plate injury?
Prevention is always better than cure. Prevention of plantar plate injury is focused on optimising foot function and reducing any abnormal stresses to the plantar plates of the foot. Our podiatrist can conduct a thorough assessment to identify any potential risk factors and provide relevant foot care and footwear education to reduce your risk of plantar plate injury. Click here to book an appointment with us today.