Are you suffering from pain under the ball of your foot? You may have a plantar plate injury. The plantar plate is a disc-shaped fibrous ligament that runs along the ball of your foot, connecting to your toe joints. Each toe has its own plantar plate that is responsible for keeping the toes together, preventing excess dorsiflexion, assisting the windlass mechanism by attaching to the plantar fascia and reducing the loads through the metatarsals.
Plantar plate injuries are commonly found at the 2nd toe due to the 2nd metatarsal usually being the longest. Tears to the plantar plate underneath the big toe is commonly referred to as “turf toe”.
Imaging is often not required to confirm this diagnosis, however an ultrasound or MRI is usually able to detect plantar plate tears. Alternately, an x-ray will not pick up a tear, however it may rule out other potential injuries that occur in a similar area.
Causes
Plantar plate tears are often associated with sports/activities that place the balls of your feet under high levels of stress, such as running. Higher loads on the metatarsophalangeal joints lead to increased strain on the ligaments, which over time may result in tears. They can either occur gradually or suddenly.
Other causes and risk factors for developing plantar plate tears include:
- Having certain toe deformities such as bunions or hammer toes, which can cause compression and tension on the lesser metatarsophalangeal joints
- Having a long second metatarsal bone or short first metatarsal bone
- Prolonged use of tight-fitting footwear causing a compression force on the forefoot
- Hypermobile feet
- Having a cortisone injection to the area can cause plantar plate tears due to its catabolic effect
Symptoms of Plantar Plate Tears
Common symptoms include pain and swelling underneath the balls of the feet and pain can increase with physical activity. Patients often describe it as like ‘walking on a lump.’ Depending on the severity you may also start to see your adjacent toes separating from each other or overlapping.
Treatment for a Plantar Plate Tears
Plantar plate tears can often take up to 6 months before you are completely pain free. Treatment initially involves reducing your symptoms, followed by a gradual return to exercise. Here are some of the options that we use in the clinic.
Short term
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- Icing and NSAID’s during the first few days to reduce pain levels
- Immobilisation of the toe joint with strapping to allow for healing
- Avoiding barefoot walking
- Reducing activity levels that cause pain
- Offloading with modified footwear, carbon fibre plates or orthotics
- CAM boot for a brief period if symptoms are severe
Long term
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- Ongoing orthotic therapy
- Return to exercise using a runner with a rocker bottom sole
- Intrinsic foot strengthening
- Proximal strengthening of the calf muscles
- Balance/proprioception exercises
- Gradual return to exercise
In the more severe cases where conservative treatment fails surgery may be recommended to repair the damaged ligament.
