What is Plantar Plate Tear?

Plantar plate tear can lead to instability of the affected toe, making it challenging to maintain balance during activities like walking or standing.

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Overview

The plantar plate is a ligament located in the ball of the foot, connecting the metatarsophalangeal (MTP) joints where the toes connect to the foot. In summary, the plantar plate plays a crucial role in holding the toes together, providing support and stability to these joints. When a plantar plate tear occurs, the affected toe may lose stability and cause it to move out its normal alignment. Plantar plate tears are most commonly found in the second toe.

The plantar plate is subjected to repetitive tension from ground reaction forces transmitted through the forefoot during movement, resulting in acute injuries or stress trauma over time.

While injuries can affect the plantar plates of any lesser toe, the second toe's plantar plate is most commonly affected. Conditions such as hammer toes, floating toes, dislocations, and toe separations often accompany plantar plate tears.

Injury to the plantar plate causes chronic swelling and persistent pain at the ball of the foot. You may feel your toes separating or even notice splaying of the toes. Over time, the toes may adopt a curled position and the foot's shape caan change due to the torn plantar plate, leading to pain.


Symptoms

Patients may feel a numbing, burning, arching or swollen sensation. A plantar plate tear can cause excessive pressure on the metatarsal head eventually leading to osteoarthritis or osteonecrosis. Common symptoms include:

  • Sudden or gradual pain in the ball of your foot, often near the base of the toes.
  • Difficulty bending or straightening the affected toe.
  • Bruising and swelling around the area.
  • A popping or snapping sensation at the time of the tear.
  • Instability and a feeling of the toe "dislocating" when weight is applied, causing difficulty in walking or running

Risk Factors

  • Trauma
  • Hypermobility
  • Hereditary factors: such as flat feet, bunions, clawed or hammer toes.

Causes

There are several factors can contribute to plantar plate tears but they are often related to repetitive stress, abnormal biomechanics or trauma. Some common causes include:

  • Abnormal biomechanics such as having high arches, flat feet or misaligned joints
  • Repetitive stress from high-impact activities, prolonged walking, running or standing and even improper footwear
  • Sudden impact or trauma from accidents, falls or sports injuries
  • Abnormal foot structure (Morton's toe and bone spurs)

This condition is common and affects individuals of all age groups and genders. It can often be seen in individuals who have made sudden increases in physical activity such as starting a new fitness program or training for a marathon.

How can Plantar Plate Tear be managed?

Early assessment and diagnosis are crucial to increase the chances of a complete and expedited recovery. A comprehensive history and diagnostic assessment will be conducted and assessed by your podiatrist, followed by an ultrasound imaging used to determine the extent of the tear and identify any underlying or secondary conditions.


For non-severe plantar plate conditions, conservative measures can offer relief by offloading and utilising various clinical therapy to help reduce inflammation and target the injury, such as the RICE method or custom orthotic devises, aimed to provide support and reduce pressure on the affected area.



Additional options, including taping, strapping or surgical interventions may be considered to address the tear and restore stability to the affected toe joint.



Depending on the patient’s assessment, care approaches may include extracorporeal shockwave therapy (ESWT) and Super inductive System therapy, and custom foot orthotics. This will help reduce pain, stimulate recovery, and prevent further injuries.



If a plantar plate injury is unaddressed, it can lead to the dislocation and development of osteoarthritis or osteonecrosis in the affected joint. This is due to the abnormal pressure on the joint that can cause the cartilage to break down and the bone to weaken. Therefore, it is important to seek help from a medical professional to prevent the condition from progressing.



It is crucial to consult with a healthcare professional, such as a podiatrist, for an accurate diagnosis and appropriate care plan based on the specific circumstances of the plantar plate tear.

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Common Symptoms

Sharp pain and/or swelling under the ball of the foot extending towards the toes
Pain that is most commonly found at the base of the 2nd and 3rd toes and intensifies when barefoot or tip-toeing
Deformity in the toes (Daylight Sign)

How It Looks Like

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Related Conditions

FAQs

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I've been experiencing sharp pain on my right foot for the past one month. I've always thought it's because of my bunion, it's been very annoying and restricted my mobility. So I was recommended to see Afnan for a consultation. She went through my medical history and took the time to get to the real problem - as I've mentioned I suspected it was because of my bunion. She did an ultrasound and physical checked on my foot and she found my problem! Turned out I've injured my plantar plate! I've totally over used it. She recommended to do focal shockwave to heal my tissues… furthermore to help lessen pressure on my plantar plates, she recommend me to have customised insoles which totally going to help me get my groove back! Thanks Afnan for your insightful consultation. I really appreciate it!

Vika Arliany
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