Your plantar plate is a ligament in the ball of your foot that provides crucial support to your metatarsophalangeal (MTP) joint where your toes connect to your foot. If part of the plantar plate tears, one or more toes can become unstable and shift out of its normal alignment, sometimes causing it to crossover another toe. And while a plantar plate tear can affect any toe in your foot, it tends to be most common in your second toe.

But what causes this key ligament to tear, and more importantly, how can you treat the issue so that you’re not dealing with foot pain and discomfort for the rest of your life? In today’s blog, we explore some of the causes, symptoms and treatment options for plantar plate tears.

Causes And Symptoms Of Plantar Plate Tears

Plantar plate tears don’t always have a specific point of origin, but there are a few different factors that can increase your risk of developing one. For starters, it’s understood that having a second toe that is longer than your surrounding toes could increase your risk of a ligament tear. Overstressing your feet, being overweight or regularly wearing shoes that don’t adequately support your arch and feet can also increase your risk of a plantar plate tear.

Symptoms of a plantar plate tear will vary depending on the progression of the injury, but oftentimes the condition presents with mild pain or discomfort around the second toe that worsens with physical activity. Some patients also say that it feels like they are walking on a pebble or a marble when putting pressure on their toe box. Other symptoms include:

• A visual shifting of the second toe
• Difficulty lifting your second toe off the floor
• More severe cases may make it difficult to comfortably wear shoes

Diagnosing And Treating Plantar Plate Tears

Because there is oftentimes a noticeable visual aspect to a plantar plate tear, these injuries can usually be quickly identified by a primary care physician or a foot specialist like Dr. McDonald. They’ll begin by asking questions about your foot, the symptoms you’re experiencing and if any actions cause symptoms to improve or worsen. From there, they will conduct a physical assessment of the toe and may have you attempt to perform a few simple actions. It’s possible that they may order an X-ray to rule out other issues or an MRI to get a better look at the health of the affected ligament, but these imaging tests are not always necessary.

The progression of your plantar plate tear will dictate your recommended course of treatment, but the vast majority of cases begin with some targeted non-operative treatment exercises. Rest, ice and compression are great early stage interventions, and over-the-counter medications can help to alleviate some discomfort. Your doctor will also work to help take stress off the injured ligament so that healing can run its course with the help of custom orthotics, toe taping techniques and gentle physical therapy exercises. Many patients see noticeable improvement over the course of several weeks or months of conservative care.

For more severe cases, or for toes that don’t respond well to conservative treatments, more hands-on care in the form of a minimally invasive surgery may be needed. While the methods may differ slightly, the goal of any plantar plate surgery will be to correct the toe deformity and create an environment where the ligament can heal in a correct position. Oftentimes this is done by pursuing one of two different procedures:

• Plantar Plate Repair – This is a more direct method that involves surgically repairing the damaged tendon and possibly altering the metatarsal bone to take pressure off the ball of your foot.
• Tendon Transfer – If the tear cannot be easily fixed, your surgeon may opt for a tendon transfer procedure where a healthy tendon is harvested and transferred to the top of the toe to help hold it in the correct position. This has a high rate of success, but most plantar plate tears do not progress to this point.

With either procedure, you will be non-weightbearing for a short period before transitioning to a walking boot. Most patients begin physical therapy after a few weeks, and most patients can return to normal activities within 2-3 months.

For more information about plantar plate tears or treating other issues with your toes, reach out to Dr. McDonald and his team today at (860) 244-8889.