The plantar plate is a thin structure that lies directly under the metatarsal joints of the foot in the lesser toes. The plantar plate helps support and stabilise the forefoot and protect the toe joints when under stress, such as when walking or running. The plantar plate is directly connected to the plantar fascia and the bottom of the lesser toes.
When under load or stress, due to walking or running, the plantar plate is subject to significant repetitive tension as the main ground reaction force is transferred through the forefoot.
Plantar plate ruptures occur when stress upon the thin structure exceed its threshold and causes a tear. This common condition affects both males and females, and is often seen in individuals who have recently begun an exercise program or have increased the intensity of their workouts too quickly.
Sufferers experience a sharp pain and/or swelling under the ball of the foot extending towards the toes. The pain is most commonly found at the base of the 2nd and 3rd toes and often worsens when barefoot or tip-toeing.
In more severe cases, a visible deformity in the toes may develop, giving the appearance of splayed apart toes. Known as a ‘Daylight Sign’, this is a clinical indication of a plantar plate rupture.
While the plantar plate is very thin but very strong, the structure can weaken and eventually rupture. Individuals who transfer excessive forces through the forefoot or suffer from overpronation, and those with hypermobile foot or high arch foot types are at an increased risk of rupturing the plantar plate.
Sudden increases in physical activity or changes in fitness activities, such as beginning a fitness program or training for a marathon, can cause symptoms to present and a partial or complete rupture to occur.
As with most lower limb conditions, the earlier it is diagnosed and treatment administered, the greater the chances of achieving quicker results with minimal therapy.
The first stage of treating a plantar plate tear includes a comprehensive history taking and diagnostic techniques such as ultrasound imaging to investigate the extent of the tear and check for any secondary conditions.
Once a diagnosis has been complete your podiatrist will discuss your options moving forward. The first aim of treatment is to focus on the reduction of symptoms. The second aim is to stimulate healing and begin rehabilitation of the affected structures. Treatment modalities may include ESWT shockwave therapy and Super inductive System therapy.
Finally the third stage of conservative treatment is to address the underlying cause and prevent further injury. The most effective method of achieving this is through the use of custom foot orthotics along with footwear advice.
Although each case varies depending on the severity of the condition and every individual responds to treatment differently, a multi-pronged approach offers the best therapeutic outcome.