The plantar plate is an area on the bottom of the joint capsule that surrounds the joints of the lessor toes. It is a powerful ligamentous structure that provides stability to the joint and serves as an attachment area of other ligaments around the joint. Sometimes that thickened ligament can get strained, which typically gets called plantar plate dysfunction. Sometimes it can progress to a small tear in the structure and can become quite painful to walk on – this is what is known as a plantar plate tear. It is a fairly common musculoskeletal problem seen by podiatrists.
Typically, it is painful under and just in front of the metatarsal head to walk on and to palpate the area. When standing the toe of the affected joint might be slightly elevated. There are some specific tests or movements that a Podiatrist can do to the toe to test the integrity of the plantar plate and to determine just how affected it is. The cause of a plantar plate tear is not that clear but there are a number of factors that do increase the chances of getting it, but mostly is it due to overuse with too much dorsiflexion of the toes (or toes if more than one is affected).
The best way to treat a plantar plate tear is to get the diagnosis right. It is usually fairly obvious clinically, but if it not clear then an ultrasound examination can be used to determine the extent of the tear. The initial treatment approach is to use taping for a plantar plate tear that holds the toe in a plantarflexed position and “rests” the plantar plate by limiting the amount of dorsiflexion of the toe when walking. A metatarsal dome placed just behind the painful area can also be useful to help do the same thing. Stiffer or rigid soled shoes or shoes with a rocker can also be used to help limit the dorsiflexion forces on the toe. If this is done right, the plantar plate tear should generally heal up over a few months. It does not happen quickly and is typically more of a slow and steady improvement over time. We have started using the Fix Toe device lately as it is a more practical approach than having to keep tape or strapping on the toe. If this does not help, and occasionally it dosen’t, then a surgical repair of the tear is indicated.