Plantar Plate Repair

The plantar plate is a thick fibrous structure located in the ball of the foot. It is attached to the toe and the head the corresponding metatarsals. The plantar plate plays an important role in keeping the toes in place, stopping them from drifting or over-extending.

Plantar plate injuries are not uncommon and are often associated with toe deformities. The most common cause of this injury is microtrauma due to shearing ground reactive forces leading to a strain of this ligament which then eventually tears completely. Often there are structural abnormalities, such as long 2nd or elevated 1st metatarsal that can predispose patients to develop this injury.

Patients usually notice pain and swelling on the ball of their foot. The toes can also become dislocated at the mpj since there is nothing holding the toe in its anatomic position any more. Pain is described as sharp with ambulation and it is of dull nature during rest. The associated toe deformities can often lead to arthritis of the adjacent bones. Although acute injuries (turf toe) are not uncommon, most often the presentation of symptoms is chronic in nature.

X-rays are taken in the office to assess the deformity. They usually show associated toe deformities that can range from hammer toes to dislocated toes. Structural abnormalities are also identified such as elevated 1st metatarsal or a long 2nd metatarsal. MRI is the gold standard test that confirms the diagnosis.

Conservative treatment includes protected weight-bearing initially to calm soft tissue down along with Rest, Ice, Compression and Elevation. Custom orthotics are also utilized to correct biomechanical abnormalities.