Plantar Plate Tears

What Is the Plantar Plate?

The plantar plate is a soft tissue structure on the bottom of the foot under the metatarsal head. The plantar plate is composed of type 1 collagen and fibrocartilage. The plantar plate attaches to the base of the toe and the metatarsal (long bone that goes to the toe).

What Is the Function of the Plantar Plate?

The plantar plate cushions the bottom of the metatarsal head while walking and running. In addition, the plantar plate helps bring the toe to the floor while standing.

What Are Causes of Plantar Plate Tears?

The following are causes of plantar plate tears:

  • A long first metatarsal
  • A short second metatarsal
  • A short third metatarsal
  • Biomechanical abnormalities and imbalances in the foot causing overload of one of the metatarsals
  • An untreated metatarsus adductus (pigeon toed) deformity
  • Arthritis of the big toe
  • Cortisone injection into the area

What Are the Symptoms of a Plantar Plate Tear?

The following problems can be symptoms of a plantar plate tear:

  • Pain in the ball of the foot that has persisted despite changes in shoes and activities
  • A second or third toe that appears to be changing position over time
  • A diagnosed ‘neuroma’ that has not been responsive to treatment

How Do You Diagnose a Plantar Plate Tear?

The proper diagnosis of a plantar plate tear as well as any underlying foot deformity starts with a physical exam. Your Weil Foot & Ankle Surgeon will take a thorough history of your foot problem. Then, he or she will examine your foot looking for:

X-Rays

X-rays will be ordered for both feet (even if the pain is only in one foot) to assess the quality and alignment of the bones of the foot. X-rays are taken of both feet in order to compare the painful foot to the non-painful foot. In addition, this will help your Weil Foot & Ankle Surgeon rule out the possibility of fractures or stress fractures in the foot.

Magnetic Resonance Imaging (MRI)

If your Weil Foot & Ankle Surgeon suspects that you might have a plantar plate tear, he or she may order an MRI or an ultrasound. Magnetic resonance imaging is one of the most sensitive imaging techniques for this particular problem. In research conducted at the Weil Foot & Ankle Institute, it was found that the overall accuracy of MRI in determining if plantar plate pathology was present was 96%. This study also revealed a sensitivity of 95%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 67%. The Weil Foot & Ankle Institute has three extremity MRI’s on site at our Des Plaines, Highland Park, and Lincoln Park locations. These extremity MRI’s only take about 30 minutes for the study and only requires the patient put their foot into a painless machine avoiding the uncomfortable claustrophobia that some MRI devices create.

Ultrasound

Ultrasound is currently being investigated for its accuracy in diagnosing this pathology. We have an ongoing study looking at diagnostic ultrasound as compared to MRI findings and intra-operative findings. The early results from this study suggest that ultrasound evaluation of the plantar plate is highly technician dependant. Although the ability of the ultrasound and technician to detect if plantar plate pathology is present is relatively high (75%), the ability to accurately detect the location of the plantar plate pathology is very low (31%).

Non-Surgical Treatment Options

Non-surgical treatment options for this pathology are initiated to help alleviate any discomfort in the foot. They include:

  • Rest
  • Ice
  • Anti-inflammatory medication – Sometimes medications such as naproxen and Celebrex can help with painful inflammation at the bottom of the foot.
  • Orthotics: Sometimes shoe inserts can help take pressure off the overstressed areas of the feet
  • Changes in Shoes: Avoiding shoes that aggravate this problem (high heels and tight shoes)

When Is Surgical Treatment Necessary?

Surgical treatment is suggested when non-surgical measures fail to alleviate pain and begin to limit your lifestyle.

Surgically this problem is corrected with a procedure invented and pioneered by Dr. Weil, Jr. This procedure has been extensively studied at Weil Foot & Ankle Institute. An incision is made on the top of the foot. The long bone causing the plantar plate to be torn is shortened and the ligament at the bottom of the foot is re-attached to the bone in the toe. In addition, any other problems in the front part of the foot (bunions, hammertoes, etc.) can be surgically treated at the same time.

After surgery, you can expect to be a bulky dressing and a surgical shoe for 7–10 days. At your first post-operative appointment, your bandages are removed and you are allowed to get back into a gym shoe. Physical therapy starts at this time and is one of the most important parts of the post-op course.

Weil Foot & Ankle Institute is a leader in researching causes, imaging and treatment related to this condition.

If you think that this problem is causing pain in your foot, call Weil Foot & Ankle Institute for an appointment today at
847-390-7666.


Publications by Weil Foot & Ankle Institute physicians on this topic:

Diagnosis of Plantar Plate Injury by Magnetic Resonance Imaging with Reference to Intraoperative Findings

Magnetic Resonance Imaging Versus Musculoskeletal Ultrasound – A Comparison of Two Imaging Modalities for Identification and Localization of Plantar Plate Pathology

The Role of the Abnormal Metatarsal Parabola in the Development of Plantar Plate Tears

Current Concepts in Plantar Plate Repair

Anatomic Plantar Plate Repair Using the Weil Metatarsal Osteotomy Approach

Corrections of Second MTP Joint Instability Using a Weil Osteotomy and Dorsal Approach Plantar Plate Repair: A New Technique

Musculoskeletal Ultrasound Evaluation of the Plantar Plate for Identification of the Plantar Plate Tears

Radiographic Exam Predictors of Plantar Plate Tears

Clinical Exam Predictors of Plantar Plate Tears