What is a plantar plate tear?
Posted: Aug 29, 2020
Pain under the ball of the foot can be due to many things and often gets given the name, metatarsalgia. This is not a diagnosis as it could signify a number of different conditions that could be causing it. One of the more common causes of metatarsalgia is a condition called a plantar plate tear, though it could also be a strain or a dysfunction. Around each joint are ligaments that make up a capsule that keep the joint together and keeps the lubrication fluid inside the joint. In the metatarsophalangeal joint in the ball of the foot, that joint capsule on the bottom side is much thicker and stronger and is called the plantar plate. This gives a lot of stability to the joint, but it is also subjected to a lot of pressure when walking or running.
When a plantar plate tear happens, there is initially pain under one of the lessor joints in the ball of the foot. The pain is also typically just distal to the joint as well. Over time that pain gets worse. Typically, there are a number of clinical tests that a skilled clinician can do to assess if a plantar plate tear is present and check the stability of the joint. If these clinical tests do not confirm it, then a diagnostic ultrasound is often done to confirm its presence if it is still suspected clinically.
When a plantar plate injury occurs, they do not heel on their own and they almost always need some form of treatment to stop it from progressing further. The first thing that is usually done is to reduce activity levels if that is possible to give the foot some rest. Ice and pain medication can be used in the short term to deal with the symptoms if they are bad, but they will not help fix the condition, they will just make it more tolerable. Strapping is usually used t hold the toe down to prevent it bend upwards (dorsiflexing). This is a very effective way to limit stress on the plantar plate to allow it to heal. This is usually very effective but can take several months of use to get the full benefit. The use of tape. However, can be inconvenient as it has to be kept clean and kept on being reapplied at regular intervals. There are some wearable removable braces that can be used instead of the strapping of a plantar plate tear. A shoe that has a stiff sole or a rocker sole can also be very help for this as well as they can also prevent movement of the joints and further rest the plantar plate.
Foot orthoses with metatarsal pads and an accommodation to keep pressure of the painful area can also be very useful. These conservative approaches normally do work, but it can take a while. They should be stuck with as long as there is a steady improvement in the symptoms. If the pain is particularly bad and the symptoms are not improving with these measures, then a surgical option to repair the tear should be considered.
Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.