Plantar plate injuries take time to heal, but most patients with mild tears can experience a full recovery with conservative treatment options.
If you have pain in the ball of your foot, it may be due to a plantar plate injury.
The plantar plate protects the metatarsals and toes from overload, such as during heavy-hitting sports like running. However, if the plantar plate experiences repetitive stress and pressure, the ligaments may tear, causing pain and other symptoms.
Receiving an early diagnosis for plantar plate tears is important. If you are experiencing pain in the ball of the foot, call Frankel Foot & Ankle.
Learn more about the plantar plate and the potential for injury below.
Plantar Plate Injuries
What is the plantar plate?
The plantar plate is a disc-shaped fibrous ligament that connects the joints of the toes to the ball of the foot. There is a plantar plate for each toe.
It is located on the underside of the metatarsal phalangeal joints (MTP joints) at the ball of the foot and it protects the metatarsal from overload. The plantar plate keeps the toes together and prevents overextension.
Plantar Plate Tear
The location of the plantar plate makes it susceptible to injuries, particularly in athletes.
A common plantar plate injury includes a tear. The second metatarsal is usually the longest, so plantar plate tears occur most commonly at the second toe.
A tear at the second metatarsal is also known as pre-dislocation syndrome, crossover toe deformity, and floating toe syndrome.
A severe case of turf toe, or a sprain in the big toe joint, can also cause plantar plate tears and sesamoiditis.
Plantar plate injuries are graded by severity. A Grade 1 tear can be treated with conservative methods, whereas a more severe tear may require surgery.
Causes and Symptoms
Common causes of plantar plate injury are sports events in which the ball of the foot is under repetitive overload or pressure. For example, runners and soccer players may experience a plantar plate tear due to the high pressure that is repeatedly placed on the metatarsals.
Other causes of plantar plate tears include:
- Over-pronation, or rolling the feet inwards while walking and/or running
- Having an untreated bunion
- Hammertoe
- Having a short first metatarsal and/or long second metatarsal bone
- Hypermobility
- Ill-fitting casual and/or running shoes
Symptoms of plantar plate injuries include pain, swelling under and on top of the foot, and some redness. In more severe cases, the toes may begin to separate and form a “V” shape or the toes may cross over each other. The sensation of walking on the bones of the foot may also be present.
Pain can be located in the second through fourth toes in the ball of the foot, and the pain increases with activity.
If you have developed a limp after activity, then the severity of the tear may have progressed. It is important to see a podiatrist as soon as you notice consistent pain in the ball of your foot to prevent the tear from progressing.
Plantar Plate Injury Treatments
As mentioned, diagnosing the injury early is necessary to prevent plantar plate tears from progressing. Plantar plate injuries can be difficult to diagnose and may require imaging to determine the severity of the tear.
Most patients with a Grade 1 tear will heal with conservative treatments, such as:
- Off-loading the plantar plate with orthotic pads
- Taking anti-inflammatory medication to reduce swelling and pain
- Reducing activity that caused the injury
- Immobilization through sports medicine taping
- Wearing proper-fitting shoes with support
With taping, the toe will be drawn downwards in plantar flexion, or pointing away from the top of the foot. This will stabilize the plantar plate and increase blood supply to aid healing.
If you have bunions, hammertoes, or other conditions, then Dr. Frankel may suggest additional treatment to remedy the stress on the plantar plate.
Treating Severe Plantar Plate Tears
If the plantar plate injury has progressed into a more severe tear, then surgery may be required. Surgery is reserved for cases in which the injury does not respond to conservative treatments or when the adjacent toe joint becomes unstable.
The plantar plate will need to be repaired to restabilize the ligaments. This is done by using advanced techniques such as creating a new ligament with special biologic tape.
Chronic cases of plantar plate tears are uncommon, but a resection osteotomy may be suggested to fix the affected ligaments.
Healing Takes Time
Even for mild tears, plantar plate injuries may take time to recover completely. It is important to be patient with plantar plate injuries and allow the ligaments to fully heal before attempting to participate in sports and heavy exercise.
Depending on the severity of the tear, patients may experience full pain-free recovery within 3-4 months of treatment. Other symptoms may improve faster and allow patients to return to regular activity within one month.
If you are experiencing pain in the ball of the foot, call Frankel Foot & Ankle to schedule an appointment today. Diagnosing the injury early will help prevent the tear from progressing and reduce the likelihood of surgery. Dr. Frankel can help you return to your favorite activities without pain by treating your plantar plate injury.
Visit Dr. Frankel to heal your plantar plate injury.
Dr. Frankel founded Frankel Foot & Ankle to provide patients in Pennsylvania, New York, and New Jersey tri-state area with the latest advances in diagnostic technology and treatment for sports medicine conditions, foot and ankle trauma response, and innovative surgical and regenerative approaches. Contact Frankel Foot & Ankle today.
