Plantar Plate Tear

What is a Plantar Plate Tear?

The ‘plantar plate’ is an important ligament underneath the joint between the toe and the foot. Over time this ligament can become worn out and eventually tears, no longer holding the toe down in its joint properly.

How does it happen?

It can be caused by badly fitting shoes and it is often related to having tight calves. If your calf is tight this pulls up on your heel, bending your ankle down, forcing your foot into the floor.

What problems does it cause?

At first it causes pain around the toe and under the ball of the foot. If left longer the toe can start to stick up in the air as the ligament isn’t holding it down anymore.

Non-surgical treatment:

It is important you are assessed by a specialist to diagnose the problem properly and design the treatment to suit your specific problem and needs.

Calf stretches are extremely important. The best time to do these is morning and evening while you are cleaning your teeth. Stand on the edge of a step (make sure it is safe and you are holding on) with your heels hanging off. Then let your heels hang down, you should feel a stretch in your calves. Hold this position for 2 minutes (the length of time you clean your teeth for). If you do this when you clean your teeth it takes no extra time out of your day and you won’t forget. Stretching your calves with a towel on the sofa is also a good idea and should be done as often as possible.

Your shoes are an extremely important part in managing this problem.

Flimsy shoes allow the toes to bend back when you walk which puts force on the painful area. Stiff soled shoes stop the joint moving too much which is painful. If you can bend shoe with two fingers, they are too flimsy. Walking boots are good for this.

Shoes with curved soles take the pressure off your toes when you walk. There are many different styles available. Search online for “rocker bottom shoes” and make sure the sole has a good curve under your toes. Make sure the soles are stiff and you can’t bend the soles with 2 fingers.

Surgery

Surgery often involves shortening the foot bone behind the toe to take pressure off the joint. This procedure is called a DMMO (Distal Metatarsal Metaphyseal Osteotomy). This can be done via keyhole surgery requiring only 1 stitch.

After surgery

It is important you follow your doctor’s advice, below is for reference only.

After surgery you should be comfortable and nearly all patients go home on the same day. You will have a bandage on your foot and a special stiff soled shoe to protect the foot while it heals.

For the first 1-2 weeks you will need to keep your foot elevated above your heart at home day and night to keep the swelling down. This reduces pain and helps the healing.

You will be allowed to walk on the foot from day 1.

At 2 weeks your bandages will come off and the stitches will be removed.

After 6 weeks the stiff soled shoe will come off and you can go back into normal shoes.

It is crucial you don’t smoke (including e-cigarettes) or take anti-inflammatories for 6 weeks after the surgery.

Plantar Plate Tear FAQs

    The plantar plates are strong ligaments under the balls of your toes that stabilise these joints where your toes join your foot (the metatarsophalangeal joints). These ligaments are incredibly important for your toes to function properly and remain in the correct position. If too much force is placed through these ligaments repeatedly, they can wear out and partially tear or rupture altogether and the position of your toe may change. This is a fairly common condition and is often misdiagnosed as a Morton’s neuroma.

    If your plantar plates are becoming worn out or torn you will likely have pain under the balls of the toes when you walk. This may feel like you are standing on a pebble, and it may make it difficult for you to walk, especially in bare feet. Your toe may start to angle sideways or lift up in the air which can be uncomfortable or cause your toe to rub on your shoes.

    As a foot and ankle specialist, I will be able to assess your foot and examine your plantar plates to see if these are tender, partially torn or completely ruptured. An MRI scan is useful to confirm the diagnosis and ensure there are no other causes of your pain. Identifying the correct cause of your pain as early as possible is crucial to implementing the right treatment.

    Non-surgical treatment can be effective at helping your pain to settle down and should be tried before surgery is considered. If this does not adequately improve your pain or you are unhappy with the position of the toe then surgery is available to correct the position of your toe using a keyhole procedure or to repair your plantar plate directly back onto the toe.

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