Plantar Plate Injuries

Solutions for runners’ plantar plate injuries

Plantar plate sprains (also known as plantar plate tears) are painful conditions that many different runners, of many different ages, can experience. They come in different levels of severity:

• Milder plantar plate tears will cause slight pain, no digital deformity and slight plantar MPJ induration. 
• More severe plantar plate tears will cause moderate to significant localized MPJ plantar edema, progressive digital deformity, painful ambulation and even digital neuritic symptoms.
• Most severe plantar tears complete tear of the ligament and results in intense pain with obvious joint deformity.

Symptoms

A plantar plate tear is a common injury of the forefoot (ball of the foot) which is caused by repetitive overload. The plantar plate is a ligament that is situated on the underside of the metatarsal phalangeal joints at the ball of the feet. The reasons for the overload can be due to the individual’s anatomy (e.g. short first metatarsal or a long second metatarsal), over pronation (rolling in), hypermobile joints and incorrect casual and/or running shoes.

Runners experiencing a plantar plate injury will describe pain in their 2nd through 4th toes in the ball of the foot that gets worse while walking or running

If you have pain beneath your 2nd, 3rd or 4th metatarsal, and it gets worse with walking, jumping or running, you may have a Plantar Plate Sprain. In the early stages of the injury it is most likely a Grade 1 Plantar Plate Sprain, which can be treated quickly and effectively using conservative methods.  You will know if the injury has progressed if your pain gets worse or you develop a limp following activity.

Treatment

Non-operative treatment focuses on off-loading the injured plantar plate with special pads or sport medicine taping and anti-inflammatories. Reducing the activity that initiated the plantar plate injury is important in reducing stress on the ball of the foot.

Surgical management is reserved for plantar plate injuries that are unsuccessfully treated non-operatively or when the adjacent toe joint becomes unstable. In these cases, the ligament is repaired using advanced techniques and sometimes a new ligament is created using special biologic tape.