Treatment of plantar plate tears
OK, so you talk about plantar plate tears and in walks a plantar plate tear to my office today. This fellow was a 70 y/o male who is retired but very active. His primary concern wasn't today but what is going to happen in 5-10 years if left untreated. He currently runs 3 miles a day and is planning a major hiking trip this summer.
Clinically my patient showed a rigid hammer toe 3 left and a very prominent ball of the foot. He described no pain with the onset of this change but noted that the change in the position of his toe happened fairly abruptly some 2.5 to 3 years ago. The 3rd toe was deviated in the sagital plane (toe moving toward the shin) and the transverse plane (3rd toe deviated towards the 5th toe). X-rays showed complete dislocation of the metatarsal phalangeal joint.
So what to do? With a plantar plate tear and complete subluxation that had been present for over two years, I gave my patient a 75% success rate with surgery. Combine that with the fact that he's relatively pain-free, I think you can see what needs to be done. At this stage, nothing. The patient's primary location of pain was on the bottom of the foot. He had tried Rx orthotics with little change in his symptoms.
We watched the video on placement of metatarsal pads and I sent him on his way. For the short term, he's doing ok. Let's just keep it that way.
Jeffrey A. Oster, DPM