, but always be sure to see a podiatrist if the pain does not improve or gets worse. High impact activities like running or playing sports, When an indirect plantar plate injury occurs it is critical to consult a podiatrist specializing in these fields to determine the cause of your injury. Surgery is not necessary in the majority of plantar plate injuries. Grade 3 Plantar Plate Sprains are more severe and will not typically respond to conservative treatment and may require surgery. Please don't hesitate to contact us at 206-344-3808. Foot and Ankle Surgeon and Director of University Foot and Ankle Institute, 17,754 Total 1st Party Reviews / 4.9 out of 5 Stars. If manufactured and molded correctly, they can keep the tension off the injury and pressure when standing and walking. See your foot and ankle orthopaedic surgeon if you are experiencing Your surgeon will perform an examination by moving the affected toe. The most common site for a plantar plate tear is under the second toe, but it can happen under any toe. While recovering, you will need to be off the foot while healing, and crutches are often suggested. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. The content is not intended to substitute This does need to be used for an extended period of time to allow for the plantar plate to heel. The plantar plate is a strong ligament on the bottom of the foot, a fibrous structure that starts at the metatarsal head and attaches to the proximal phalanx through the joint capsule within the forefoot. to see one of our skilled podiatrists at the Foot and Ankle Center of Washington as soon as possible. Subscribe to our newsletter to receive our Free list of recommended shoes: Some of the links below are affiliate links, which means that if you choose to make a purchase, we will earn a commission. The pain is most commonly under the head and distal to the head of the second metatarsal. If you have a seated, office type job where you do not put weight on your foot and you can elevate your foot all day, you may be able to return as soon as 1 week after surgery. If these measures dont help or if a deformity has already formed, surgery is an option. pain under your toe or other symptoms. Collateral ligaments. It provides dynamic and static joint stability while protecting the joint's articular surfaces. If the dye leaks out the bottom of the joint this may confirm a plantar plate tear, see image below. Treatment initially consists of icing, NSAIDs, relative rest, plantarflexion strapping of the digit, and accommodative padding to reduce loads under the affected metatarsophalangeal joint. Three 8-9\" pieces of 1/2\" cloth adhesive tape are used to prevent the proximal phalanx of the affected digit from dorsiflexing during propulsion which, in turn, prevents excessive tension force on the plantar plate to allow it to become less inflamed and, hopefully, heal over time while the patient continues their normal weightbearing activities.Digital plantarflexion taping, along with twice daily plantar icing therapy (i.e. Diagnosis is made clinically with the inability to hyperextend the hallux MTP joint without significant pain and the inability to push off with the big toe. Left and right arrows move across top level links and expand / close menus in sub levels. These cookies track visitors across websites and collect information to provide customized ads. Certain foot types, such as feet with high arches can place additional pressure on the plantar plate, and make you more prone to injury. This is why bringing your shoes with you to the doctors office is critical. The main cause is usually an abnormally high amount of pressure on the associated metatarsophalangeal joint (MPJ region). Affiliate Disclosure Although plantar plate tears can occur suddenly, they most often develop slowly over time from progressive degeneration of the ligament from repetitive overuse or abnormalities including: Plantar plate injury with medial toe deviation and surgeons incision placement. Another thing I haven't done during this time is a good job blogging about my partial plantar plate tear injury. Once the head of the metatarsal is moved out of the way the surgeon will identify the plantar plate tear, or the remaining pieces of the plantar plate, and repair them. The best way to avoid pain after surgery is by icing, protecting and elevating the foot, and taking any medications your doctor prescribes in a timely manor. Symptoms Your symptoms may change depending on the stage of the injury. This cut is known as an oblique osteotomy, and it heals very well, making it a practical addition to the plantar plate repair surgery. This thick, fibrous tissue under the MTP joint prevents the big toe from bending too far upward (dorsiflexion). The sooner you start treatment, the faster you can start recovery. You may have to be non-weightbearing (keep all weight or some weight off the leg) for a short period of time to protect the repair. Please do not spend any money on these products unless you feel you need them or that they will help you achieve your goals. The surgeon will place the metatarsal head back into alignment and stabilize the bone cut with a single small screw. While these shoes were popular, they provide your foot with little to no support and can actually make you more prone to plantar plate injuries, among many other types of injury. The exam will also include a, Plantar Plate Taping and padding the affected toe, Non-weight bearing period of 6-8 weeks for severe cases, Custom orthotics designed to conform to your foot and arch tightly. "I flex the toe 10 degrees, bringing it lower than the adjacent toe, so the edges of the torn plantar plate come together. Q: What is the success rate for Plantar Plate repair surgery? Many plantar plate injuries occur because your toes dont have the rigid support they need from a shoe. Which is better, Arthrex CPR or the HAT-TRICK Procedure? A plantar plate injury is one of several possible causes of pain under the ball of the foot, most commonly under the second toe. Youll notice as it loses its strength. Plantar plate tears are most common in the second toe. This may be 4-12 weeks depending on your own unique rate of healing. Planar plate tears are a very common injury and have become a topic that Nick has become very interested in, writing a number blogs articles, presentations and is looking to publish some. Using the proper tape and a unique taping technique, the toe can be splinted in a position that helps it to heal. This website uses cookies to improve your experience while you navigate through the website. An acute injury tear might be treated by taping the foot or casting might be necessary. Continue with Recommended Cookies. [1] It comprises the plantar aspect of the first metatarsophalangeal joint (MTPJ). [1] The lesser toe plantar plates also provide joint stability and articular surface protection. Q: I was recently diagnosed with a non-retracted tear of the 2nd and 3rd planter plate. Arthrogram may done using X-ray, MRI or CT imaging. Surgery may be recommended if the toe remains painful with deformity after non-surgical treatment or is too stiff to treat non-surgically. He offers Online Physiotherapy Appointments for 45. This allows us to coordinate all services and specialties for our patients in a single location and allows for your team of doctors and therapists to communicate directly and regularly about your treatment plan. Frustrating. We do not endorse non-Cleveland Clinic products or services. Its job is to keeps the toes in place and stops them from over-extending or drifting. Click here to Schedule an Appointment Today! An MRI or ultrasound may also be used. Patients describe pain on the underside of their foot when walking, standing or running; as the condition deteriorates, this pain can become more constant. The arch height can be adjusted via pads that can be inserted under the cover. Successful treatment can take several weeks or months. Tape may be wrapped around the toe to hold it in a downward position for several weeks. Patients who recognize the symptoms of aplantar platetearand have it evaluated by a specialist can receive the best treatment quickly, avoiding more complicated and harder to repairplantar platetears. Treatment involves placing and holding the affected toe in a position that allows the tear to heal. Orthotics may be prescribed to stiffen the sole of your shoe. Plantar plate injury occurs frequently in people who have hammertoe deformities, this is likely due to the increased pressure on the metatarsal head when the toes form a claw like shape. Treating Plantar Plate Tears. You will receive medicine through an IV or mask that makes you drowsy and relaxed, as well as pain medications. In some cases, a special radiographic x-ray with a dye is injected into the joint to find the tear in the ligament. A ligament attaches a bone to a bone, and the Plantar Plate is a strong ligament that spans across the forefoot connecting to the joint capsule of each metatarsal head. We often find that there is no known direct cause for a plantar plate injury, and you may notice the ball of your foot just slowly begins to hurt and feel worse over time. I would try to leave a taping on for as long as it is still doing its job. If we operate on the right foot, you will be wearing a surgical boot for 4-6 weeks, and unable to safely maneuver the petals of the car. The MRI will show the plantar plate ligament and if it has any joint effusion, thickening, and partial to complete plantar plate ruptures. The. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". A steroid injection can be beneficial in stubborn cases that fail to improve despite the appropriate care. This entails identifying and eliminating the deforming activity or force. Plantar Plate Tears can be caused by a repetitive overload of the Plantar Plate or by a sudden overload of the Plantar Plate. You may also feel a knot or swelling in that area that feels like you are walking on marbles. There is a way to test the integrity of the ligament, called the Lachmans test or the drawer test, but it is no longer considered reliable. The HAT-TRICK allows for a more customized and specific osteotomy of the metatarsal. Even when you are fully recovered, it is likely that the toe will feel stiffer than it did before. There are a handful of resources and even videos about how to tape your toes in a plantar flexed position to help you heal from a plantar plate tear.