Plantar plate tear - treatment with a spring plate
The plantar plate is a broad, firm pad of tissue found on the plantar surface of the metatarsal phalangeal joint. The plantar plate is often referred to as a ligament but is actually firm fibro-cartilage and resembles the menisci of the knee. Plantar plate is incorporated into the plantar aspect of the metatarsal phalngeal joint capsule and acts as an anchor point for a number of muscles that cross the metatarsal phalangeal joint. The most common location for a plantar plate tear is the 2nd metatarsal phalangeal joint. (#4 on the image above)
Tears of the plantar plate are categorized as acute or chronic. In my 30 years of practice I can count on one hand the number of acute tear of the plantar plate that I have treated. Chronic tears of the plantar plate do appear more commonly. Chronic plantar plate tears are the result of repetitive load bearing of the forefoot and fatigue of the plantar plate. Chronic tears result in displacement of the toe in the sagital plane which results in a hammer toe, or in the transverse plane that results in deviation of the toe against an adjacent toe. In long term chronic plantar plate tears, subluxation of the toe does occur. Subluxation is the term used to described dislocation of the metatarsal phalangeal joint.
Acute tears of the plantar plate are the result of an abrupt force being applied to the toe, usually in a dorsal direction (toe toward the shin). Symptoms include acute onset of pain, swelling and bruising. A motor vehicle accident or sports accident would be two of the most common contributing causes of acute plantar plate tears.
Chronic plantar plate tears are much more common and present over a period of months to years. Symptoms include pain on the bottom of the metatarsal phalangeal joint. Pain increases with the duration of time spent on the feet. Bruising is not found and swelling also varies with the amount of time spent on the feet. The most common spot for chronic plantar plate tears is the 2nd metatarsal phalangeal joint.
Carbon fiber spring plates are often used to treat plantar plate tears. The spring plate acts as a splint or brace for the plantar plate. The toe spring also helps to off-load range of motion of the forefoot, decreasing the load applied to the injured plantar plate and decreasing range of motion of the joint. Toe spring is the term used to described the curvature of the spring plate from the ball of the foot to the tips of the toes.
Use of a carbon fiber spring plate may heal an acute plantar plate tear over time without surgery. The symptoms of a chronic plate tear can be managed with a spring plate but rarely do chronic plantar plate tears actually heal without surgery.
Jeffrey A. Oster, DPM
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