plantar plate – nyulawglobal

What is a plantar plate injury in the foot?

December 31, 2023 No Comments

Surrounding every joint in the body is what is known as a joint capsule. That capsule is what supports the bones either side of the joint together and keep the fluid in the joint that lubricates the joint in position. Parts of that joint capsule are usually thicker and stronger. These thicker and stronger areas would be the ligaments which give stability to the joint. In the joints on the base of the toes in the foot, the metatarsophalangeal joints, the thickened underside of that joint capsule is typically called the plantar plate. This needs to be thicker and stronger as we place a whole lot of force through it whenever walking and running and it has to be able to take it. From time to time that force may be so high it will strain that plantar plate or ligament and it will become painful. When this occurs, the technical name is plantar plate dysfunction and frequently it might go on to a minor tear in the plate, so will get known as a plantar plate tear.

Most of the symptoms for this plantar plate injury are pain under the joint whenever walking or on palpation, with the pain being more established toward the front edge of the joint. It generally only affects one joint but in some cases several may be affected. The toe can be moderatly raised as the plantar plate is not able to hold the toe down due to the injury to its integrity from the strain or tear. Quite often the diagnosis is obvious, however, if not an ultrasound assessment is commonly carried out to confirm it. The treatment for plantar plate injury normally includes taping the toe to hold it in a downward position so the plantar plate is under less load to give it a chance to recover. A metatarsal pad may also be used in the footwear to help keep weightbearing from the affected region. If these methods don't help, then a surgical repair of the plantar plate tear are usually necessary.

What casues a tear in the plantar plate?

There's a peculiar feeling which may happen under the forefoot that is commonly described as a feeling that the sock is bunched up beneath the toes, but when you checked it it is good. The sensation is commonly referred to and it is often confusing. Most likely the sensation is because of a problem with a ligament on the base of one or more of the metatarsophalangeal (toe) joints of the foot known as plantar plate dysfunction. Around each joint, there's a strong covering called the joint capsule. Parts of each joint capsule are thicker and these are the ligaments that secure and stabilise the joints. Under the bottom of the metatarsophalangeal joints, that joint capsule is thicker to create what is called the plantar plate. It is possible to strain or even get a small tear in that plantar plate, which in turn causes that sensation of a sock that seems like its bunched up below the toes.

Pain usually begins gradually below the ball of the foot and may be preceded with that weird bunched sock feeling. The typical manifestation of plantar plate dysfunction is soreness on palpation in the region of the plantar plate. An experienced clinician will move the joint in such a way to detect if the plantar plate is impaired. A definitive diagnosis may be accomplished with a diagnostic ultrasound, but it can be fairly evident to a experienced clinician on assessment. Usually the initial treatment solutions are strapping to hold the toe pointing down to ease the strain on the ligament. A metatarsal pad can be often used to help reduce the stress on the ligament. This often assists most cases of plantar plate dysfunction and get rid of that unusual experience of a bunched up sock below the ball of the foot. When those conservative measures will not help, surgical repair of a partial or complete rip of the plantar plate is commonly undertaken.