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Plantar plate injury

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What is a plantar plate injury?

The plantar plate is a fibro-cartilagenous tissue that connect the metatarsal bones to the toe bones (phalanx). It helps to maintain the toes in their correct position. Pressure through the balls of the feet, problems with foot mechanics, or and injury of the area can cause the plantar plate to tear or even completely rupture.

The most common plantar plate to be injured is at the 2nd metatarsophalangeal joint, so it affects the 2nd toe and ball of the foot just adjacent to the big toe joint.

Injuries can sometimes happen suddenly due to trauma or impact, and people often describe a sharp or sudden pain or perhaps a feeling of stepping on a stone or like something is in their shoe, but there is nothing visible when they investigate. An injury like this can lead to pain and swelling and visible deformity of the affected toes. This is often because of a partial tear of the plantar plate, and the toe pre-dislocates.

If there is a total tear or rupture, the toe may become fully dislocated.

The other onset of this problem usually involves a slower deterioration in the plantar plate often due to overload from problems with the big toe joint such as a bunion, or due to activities, footwear or weight. This can mean that the toe moves and pre-dislocates over time, placing more stress through the plantar plate as this happens. If the plantar plate is already under stress, it sometimes doesn’t take much in the way of impact or overactivity to cause a tear and the onset of more acute pain, swelling and deformity.

How can I help myself?

Management of this problem requires reducing stress through the joints and the plantar plate to try and help them settle down and allow healing. In the short term, resting, activity modification and wearing thicker soled and more “cushioning” footwear may help. If there is deformity, dislocation or pre-dislocation to the toes though, this can be very challenging to manage.

ICE and anti-inflammatory medication may also be useful to help with pain and swelling in the short term, but it is important to get an assessment of the area.

Point of interest: The “Churchill sign” is a name given when two toes spread apart in different directions, creating a “V for victory” shape. This may be related to a plantar plate problem, but is also commonly associated with inter digital neuroma.

When to see a Podiatrist?

See a Podiatrist if you can’t control the pain under the ball of your foot or if there is any sign of deformity of the toes.

A podiatrist will be able to offer specific footwear advice and check your foot and ankle mechanics. They may offer exercises if appropriate, strapping techniques to stabilise the toes (and reduce joint movement and loading) and foot orthoses  or insoles if appropriate.

Sometimes imaging is needed to further assess the plantar plate and surgery can also be indicated if the tear is unlikely to heal or the deformity of the toes needs surgical management. There is more information on the lesser toe deformity page and capsulitis page too.

If you book an appointment, it is a good idea to take the shoes you wear on a daily basis, and any sports or exercise specific footwear your use.

Plantar plate injury