- 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.
- Dull ache or sharp pain the ball of the foot.
- Sensation of not enough cushioning between the bone and the ground.
- In relaxed stance a dorsiflexion deformity of the toe may be noted.This is often accompanied by a crossover deformity.
Tests and Imaging
- Pain at the base of the proximal phalanx may be aggravated by dorsiflexion of the joint.
- 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.
- X-rays show the degree and angles of the deformity as well as any arthritis in the joint.
- MRI is also used to evaluate the extent of damage to the plantar plate.
- Limit activity.
- Corticosteroid injection may provide temporary pain relief.
- Podiatrist for strapping to stabilise the toe, footwear advice/modification, padding and insoles/orthotics to offload the affected joint.
- Foot and ankle surgeon for surgical correction if there is severe deformity.