Plantar Plate tear/rupture

Summary

  • The plantar plate is a fibrocartilaginous structure between the base of the lesser toe and the metatarsal, and maintains the integrity and alignment of the metatarsophalangeal joint.
  • Specific injury to the toe and joint or repeated overuse can cause a plantar plate tear.
  • This can cause pain and deformity to the toe leading to a dislocation of the toe.
  • The condition typically involves the second toe and is often misdiagnosed as a neuroma.

Diagnostic tips

  1. Dull ache or sharp pain the ball of the foot.
  2. Sensation of not enough cushioning between the bone and the ground.
  3. In relaxed stance a dorsiflexion deformity of the toe may be noted.This is often accompanied by a crossover deformity.

Tests and Imaging

  1. Pain at the base of the proximal phalanx may be aggravated by dorsiflexion of the joint.
  2. The modified Lachman’s test can also be utilized. The metatarsal head is stabilized and the proximal phalanx is dorsally translocated. A 2mm or 50% joint displacement is a positive sign of plantar plate laxity.
  3. X-rays show the degree and angles of the deformity as well as any arthritis in the joint.
  4. MRI is also used to evaluate the extent of damage to the plantar plate.

Immediate Treatment

  1. Limit activity.
  2. Analgesia.
  3. Corticosteroid injection may provide temporary pain relief.

Possible Referral

  1. Podiatrist for strapping to stabilise the toe, footwear advice/modification, padding and insoles/orthotics to offload the affected joint.
  2. Foot and ankle surgeon for surgical correction if there is severe deformity.

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