Plantar Plate Tear

Werribee Podiatrist Ifrah Atosh talks about plantar plate injuries.

The plantar plate is a ligament structure which help hold the toe to the balls of the feet. The plantar plate runs under the balls of the feet and holds the toe down. This may be one of the signs of having this condition (elevated or raised toe compared to the others)

Plantar plate injuries will present with pain under the balls of the feet and pain which is quite specific to this ligament location.

Causes:

• Hypermobility

• Trauma

• Rheumatoid Arthritis

• Overuse injury

Imaging may be required to confirm the diagnosis of the plantar plate injury, as there are a number of structures in the area that can be injured and have similar presentations- but totally different treatments. This is why getting an accurate diagnosis early is important as you could be wasting time, effort and money or even worse doing more harm! Imaging will often involved an X-Ray to rule out bone pathology, US is the quickest and cheapest way to try get a diagnosis but may not always show up but an MRI is the best option for picking up plantar plate tears.

Treatment for plantar plate tears/ruptures should be carried out as soon as possible, due to the delayed treatment reducing the success of treatment due to the poor blood supply to ligaments.

Treatments can include

• If acute- Ice and NSAID’s, but if not acute- heat and massage to the plantar muscles of the foot.

• Stretching of the toes should NOT be carried out

• Calf raises should NOT be done

• Taping toe down to reduce pull on the ligament and help enable it to knit back together.

• Stiff soled shoes so it doesn’t encourage dorsiflexion

• Padding in footwear

• Orthotics- Reducing the pressure in the forefoot area.

• Shockwave therapy- speed up the healing process to the plantar plate, but this needs to be done in conjunction with the other treatments to ensure less pressure in the area.

• STERIOIDS- NOT RECOMMENDED due to the risk of further damage.

• Surgery

As you can see with the plantar plate, some treatments are not recommended due to causing further issues. Therefore it is best to get an accurate diagnosis and treatment plan first.