Plantar Plate Injury

What is a Plantar Plate Injury?

A plantar plate injury occurs when the plantar plate, a small ligament that anchors the toe to the ball of the foot, becomes torn or ruptured. This can result in the affected toe becoming elevated in its position and causing tenderness under the ball of the foot.

Plantar plate injuries often coincide with other foot problems, such as hammer toe and bunion deformities. To diagnose a plantar plate injury, imaging of the foot may be necessary, including X-rays, ultrasound, and occasionally MRI scans. These imaging techniques help to assess the extent of the injury and aid in developing an appropriate treatment plan.

man doing flatfoot correction gymnastic exercise walking on massage mat at home
What Causes Plantar Plate Injuries?

Plantar plate injuries can occur due to various factors, including:

  1. Accidental injury: The plantar plate can be torn or ruptured as a result of sudden trauma or injury to the foot. This may occur during activities such as sports or from stubbing the toe.
  2. Progressive degeneration: Over time, the plantar plate may undergo progressive degeneration, leading to weakening and eventual tearing of the ligament. This degeneration can result from repetitive overuse of the foot or from underlying toe abnormalities, such as bunions or hammertoes.
  3. Toe abnormality: Conditions like bunions or hammertoes can contribute to the development of plantar plate injuries. These toe deformities can alter the biomechanics of the foot, placing increased stress on the plantar plate and making it more susceptible to injury.
  4. Repetitive overuse: Engaging in activities that involve repetitive movements or high levels of stress on the foot, such as running or dancing, can also increase the risk of plantar plate injuries over time.

Overall, plantar plate injuries may result from a combination of factors, including trauma, degeneration, and underlying foot abnormalities. Identifying and addressing these contributing factors is crucial for effectively managing and preventing plantar plate injuries.

What are the Treatment Options for Plantar Plate Injuries?

Treatment options for plantar plate injuries include both non-surgical and surgical approaches:

  1. Non-Surgical Treatment:
    • Toe Splint: Using a DARCO toe splint or a budin splint can help stabilize the toe and reduce foot pain associated with plantar plate injuries. While this does not cure the injury, it can provide support and alleviate discomfort.
    • Orthotics: Custom orthotic devices can help improve overall foot function and biomechanics, which may reduce stress on the plantar plate. However, they do not repair the damage to a torn or ruptured plantar plate.
  2. Surgical Treatment:
    • Surgical intervention: In many cases, surgical treatment is the most effective option for plantar plate injuries. Surgical procedures aim to repair or reconstruct the damaged ligament, restoring stability to the toe and relieving pain.
    • Surgical techniques may involve repairing the torn or ruptured plantar plate, reattaching it to the bone, or using tissue grafts to reinforce the ligament.

The choice between non-surgical and surgical treatment depends on various factors, including the severity of the injury, symptoms, and individual preferences. Consulting with your podiatric surgeon is essential to determine the most appropriate treatment plan tailored to the specific needs of the patient.

What Happens During Surgery for Plantar Plate Injuries?

During surgery for plantar plate injuries, the following steps are typically involved:

  1. Incision: An incision is made on the top of the foot over the affected toe to allow access to the plantar plate.
  2. Bone Preparation: The metatarsal bone (the long bone in the foot) is cut and moved away to provide clear access to the plantar plate.
  3. Repair of Plantar Plate: The torn or ruptured plantar plate is repaired and reattached to the base of the toe. This restores proper alignment of the toe and stability to the foot.
  4. Realignment of Metatarsal Bone: The metatarsal bone is then realigned to its proper position and secured back together using screws.
  5. Repair of Hammer Toe (if present): If there is a concurrent hammer toe deformity, it will also be addressed during the surgery. This may involve straightening the toe and fixing it in the corrected position, often using temporary wires that remain in place for several weeks.
  6. Postoperative Care: After the procedure, the patient is typically placed in a postoperative shoe to facilitate weight-bearing. Full weight-bearing is often allowed after 48 hours. The correction achieved during surgery tends to be solid, leading to improved alignment and function of the toe.

Overall, surgery for plantar plate injuries aims to repair the damaged ligament, correct any associated deformities, and restore proper alignment and function of the affected toe and foot.

Please follow this link to see an animated version of the operation that you have been offered to correct the rupture of the plantar plate, this is courtesy of Arthex.

Are There Risks or Side-Effects Following Surgery for Plantar Plate Injuries?

Surgery for plantar plate injuries carries potential risks and side effects, including:

  • Pain
  • Swelling
  • Infection
  • Deep vein thrombosis
  • Complex Regional Pain Syndrome (CRPS)

Specific complications of plantar plate injury surgery may include:

  • Loss of sensation around the operation site
  • Sore and noticeable scar line
  • Stiffening of the joint, resulting in reduced movement
  • Recurrence of the deformity
  • Failure of bones to fuse together, possibly requiring additional treatment
  • Overload and pain in adjacent metatarsal bone due to shortening
  • Revelation of other foot problems post-surgery

It’s essential to discuss these risks thoroughly with Mr. Earnest before undergoing surgery, ensuring you are fully informed about potential outcomes and complications.

What Happens After Surgery?

After surgery for plantar plate injuries, you will be taken back to the ward. Once you are able, you should start taking your prescribed painkillers. Your podiatric surgeon will visit you on the ward after the operation to address any questions you may have and ensure that you are ready to leave the hospital. You will be provided with a special post-operative shoe, and the need for crutches will be discussed with you beforehand.

It’s important to note that you should not drive after foot surgery, so you should arrange for a responsible adult to accompany you home.

You will also receive information about your follow-up appointment date, where your progress will be monitored and any further treatment or adjustments will be discussed as needed.

Mr Barlow-Kearsley, with years of experience treating plantar plate injuries, can provide personalized advice on the right treatment plan for you.