Plantar Plate Injury: causes, symptoms and treatments

What causes plantar plate tears?

The most common cause of plantar plate tears is excessive pressure on the associated metatarsophalangeal joint. This causes strain on the plantar plate and can eventually cause it to tear, resulting in joint instability and pain.

While sudden plantar plate tears aren’t impossible, they usually develop slowly over time from ongoing strain. Repetitive overuse or foot abnormalities can cause progressive degeneration of the ligament.

The most common causes of plantar plate injuries include:

• Biomechanical abnormalities: A short or elevated first metatarsal and a long second metatarsal can put constant pressure on the plantar plate and contribute to its degeneration.
• Bunions (hallux valgus): Pressure on the toes from a bunion can also increase pressure on the plantar plate, leading to thinning and tearing.
• Cortisone injections: Overuse of cortisone can occasionally cause weakening and thinning of the plantar plate ligament.

What are the symptoms of a plantar plate injury? 

Plantar plate injury symptoms can range from mild to severe. They may flare only when you participate in physical activities, or they might consistently cause discomfort even when your foot is at rest.

Pain and Swelling

Plantar plate injuries are a common cause of metatarsalgia (forefoot pain). You may feel a dull ache or sharp pain in the ball of the foot, and it may feel as though there is not enough cushion between the bone and the ground.

Discomfort can increase during dorsiflexion of the foot, which occurs when walking or running. Weakening of the plantar plate in the lesser toes may cause a gradual increase in pain while those in the big toe can cause severe ball of foot pain and swelling.

Shifting of the toe

As the tear increases, the affected toe (most commonly the second or third toe) shifts upwards or to one side. The second toe moving towards the big toe is particularly common with plantar plate tears. When the foot is placed on the ground, the toe may lift or appear bent.

Chronic Plantar Plate Injury

If not treated correctly, plantar plate tears become chronic, increasing the likelihood of long-term deformity. As the deformity progresses, the cartilage in the joint capsule can become eroded, leading to arthritis and more severe pain.

Diagnosing a plantar plate tear

Our podiatrists begin the diagnostic process by reviewing your medical history and symptoms. We’ll also perform a physical examination of the affected foot, testing for any limitation or pain during flexion.

To confirm a plantar plate injury (and rule out other possible causes of foot pain), the podiatry specialists at University Foot & Ankle Institute turn to radiographs. Weight-bearing X-rays specifically are very useful for measuring the degree of the injury and formulating a treatment plan.

We also have access to magnetic resonance imaging (MRI) to view the status of your foot ligaments.

Conservative treatments for plantar plate injuries

At UFAI, we opt for conservative treatment whenever possible. When caught in the early stages, conservative plantar plate treatment can be highly successful.

Our conservative options may include:

• Pain management: Over-the-counter anti-inflammatory pain medication can keep you comfortable while your plantar plate heals. Icing the area for short periods throughout the day can also bring down swelling and reduce pain.
• Support the joint: Taping or strapping the affected joint is useful for holding the joint in place, reducing stretching, and allowing the ligament to heal. We sometimes turn to stiff-soled shoes or splints to further limit mobility and support the area.
• Orthotics: Supportive shoe inserts can also provide support to the ball of the foot, take pressure off, and prevent re-injury.

If your toe has drifted significantly, this indicates that the ligaments around it have stretched. Conservative treatments may ease the pain, but surgical correction is necessary to return the toe to its position.

Plantar plate repair surgical intervention techniques

While it’s important to exhaust all conservative treatment options first, should surgery be required, our doctors are trained in the most up-to-date plantar plate surgical treatments.

The HAT-TRICK procedure

Our surgeons worked directly with manufacturers and scientists to design a product that has revolutionized plantar plate repair: the HAT-TRICK.

Because plantar plate tear surgery rarely requires operating solely on the plantar plate, the HAT-TRICK procedure combines three systems that work together to heal your foot. The HAT-TRICK joint repair system is a minimally invasive method of repairing the metatarsophalangeal joint to return lost joint stability.

When hammertoes or claw toes have been caused by your plantar plate injury, the HAT-TRICK proximal interphalangeal joint fusion system offers a non-invasive implant to straighten your toes.

HAT-TRICK’s third system (the osteotomy guide) shortens the metatarsal bone and can restore your full range of motion. It also offers an improvement over the current standard of care, the Weil Osteotomy.

Complete plantar plate repair system (Arthrex CPR)

The Arthrex CPR system is a unique device for correcting a plantar plate rupture and dislocation of the metatarsal phalangeal joint. The Arthrex CPR System directly repairs the plantar plate, reducing the risk of recurrence.

Which is better, Arthrex CPR or the HAT-TRICK procedure?

Although the Arthrex CPR is easier for many surgeons to use, several benefits make the HAT-TRICK MTP Joint Repair System a better choice, including:

• Arthrex CPR is only for plantar plate issues, whereas HAT-TRICK allows for the repair of the plantar plate and adjacent ligaments.
• The HAT-TRICK offers a better grip on the plantar plate.
• The Peek implant of the HAT-TRICK allows sutures to be tensioned and tied into the bone, whereas Arthrex CPR does not.
• For increased accuracy, the HAT-TRICK offers an osteotomy guide for the metatarsal, whereas Arthrex CPR does not.
• The HAT-TRICK is a more stable system, allowing you to start physical therapy earlier, leading to a faster recovery.

What is plantar plate surgery recovery time?

The recovery period following direct repair of the plantar plate can take four to eight weeks. The plantar plate is a very strong ligament, and it takes time with reduced activity levels to heal, but when it does, you will be pain-free!

During plantar plate tear surgery recovery, you must be off your foot, and crutches are often recommended. Depending on the extent of the surgical repair, you may be placed in a removable boot or a cast.

How to prevent plantar plate tears

It is much more difficult to treat chronic plantar plate tears than to prevent them. Patients who recognize the symptoms of a plantar plate injury and have it evaluated by our specialists receive the best treatment quickly, avoiding the need for more complicated procedures.

If you start early and know your risks, you can protect your feet from plantar plate injuries.

Custom orthotics

Patients with certain biomechanical factors that put additional pressure on the forefoot (such as a long second metatarsal, elevated first metatarsal, or short first metatarsal) should use an orthotic to distribute pressure away from the problem area.

Athletes and runners should also have their feet evaluated by our specialist to see if they are putting additional load on the forefoot.

Proper shoes 

Certain shoes will increase pressure on the forefoot. Many running shoes have a rocker forefoot that offloads pressure away from the ball of the foot. Overly flexible shoes can put additional pressure on the forefoot, increasing the risk of plantar plate tear.

Avoid steroid injections into the joint 

Many patients often want a quick fix and opt for a joint injection when the tissue is irritated. Although steroid injections can help manage pain, they can weaken soft tissue structures, including the plantar plate. Therefore, steroid injections should be avoided in the lesser toe joints as much as possible.

Accurate diagnosis of a plantar plate tear is critical 

 Plantar plate injuries are often misdiagnosed as hammertoes, neuromas, or capsulitis (inflammation of the tendons that surround the toe joints). A misdiagnosis means the underlying condition isn't treated, and the pain and deformity will continue to worsen.

UFAI has the most advanced procedures to treat your plantar plate injury 

When you choose the University Foot and Ankle Institute, you can rest assured that you have chosen a compassionate team of experts with decades of combined experience. Our team of physicians uses state-of-the-art equipment to offer the latest diagnostic, including an on-site imaging with an open MRI for the foot and ankle and a weight-bearing 3D CT scan.

While we always exhaust plantar plate tear conservative treatment options first, should surgery be needed, you will be in the best hands. Our top notch curative treatments, like the the HAT-TRICK™ and the Arthrex Complete Plantar Plate Repair System (CPR™), boast some of the highest success rates in the nation.

For a consultation please call (877) 736-6001 or make an appointment online now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot and ankle surgeons are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Sherman Oaks, the San Fernando Valley, Manhattan Beach, the South Bay, LAX, Calabasas, Agoura Hills, Westlake Village, Valencia, Santa Clarita, and Santa Barbara.

Frequently Asked Questions about Plantar Plate Tears and Plantar Plate Surgery

 

Can a plantar plate tear heal on its own?

A plantar plate tear, an injury to the ligament structure on the ball of the foot beneath the toe joints, can sometimes heal on its own, especially if it's a minor tear. However, the healing process typically requires specific measures and time. 

What is the success rate for Plantar Plate repair surgery?

UFAI's success rate is currently over 95%. The level of total correction can depend on the amount of damage but basically, it is always repairable.

 

Can you recommend some good shoes for plantar plate injuries?

We recommend a shoe with a stiff sole for plantar plate injuries. If you are looking for athletic footwear, Hoka is a good athletic shoe.

 

 

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