University Foot & Ankle Institute
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Toe Conditions: Plantar Plate Tear

Plantar Plate Tear - University Foot and Ankle Institute

What is the Plantar Plate?


On the bottom of each lesser toe joint (excludes the big toe), there is a ligament between the base of the toe and the metatarsal (foot bone).  This ligament is called the plantar plate. The ligament keeps the toe in the joint and prevents it from over extending or drifting out of normal range.


In the gait cycle the toes bend at the base of the toe joint, just before the foot pushes off the ground. The plantar plate holds the toe in place and brings the toe back straight. There is no muscle associated with this ligament.


UFAI, the right choice for plantar plate treatment


The successful treatment of Plantar plate tears depends on an accurate diagnosis and proper procedure selection. University Foot and Ankle Institute has the latest testing and diagnostic technology available for proper analysis of the foot and ankle. Our team of specialists work in the most-conservative manner to get you back to your life and activity in the most cost-effective and non-invasive manner possible.


I am so grateful to have found you. I was dealing with so much pain and frustration for a lack of diagnosis. You have been very patient with me and all my questions and concerns. I appreciate how you take the time to sit down and talk. You are very good at what you do and I think it is important for you to know. Brittania
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University Foot & Ankle Institute is a Preferred Provider to:
and consulting physicians for:

What Causes a Plantar Plate Tear?


A plantar plate tear is caused by repeated overuse or a specific injury to the toe and joint. These circumstances can create excess pressure through the ball of the foot and metatarsal bone area.


With time the ligament may overstretch or tear, resulting in pain.  Lack of proper treatment may result in a deformity of the toe which leads to a dislocated toe.


The condition typically first involves the second toe and is often misdiagnosed as a neuroma.  



Plantar Plate Tear Symptoms


Patients often describe the pain as a dull ache or sharp pain the ball of the foot. It may feel as though there is not enough cushion between the bone and the ground.


Over time, as the tear increases, the toe will begin to shift upwards or to one side. When the foot is placed on the ground the toe may not touch. When the toe is elevated in this way, more pressure is placed onto the head of the metatarsal, causing bone bruising and pain.


When the ligament tear becomes chronic, the deformity can be greater, leading to a severely deformed toe and hammer toe. As the deformity progresses, the cartilage in the joint can become eroded, leading to arthritis and increased pain.



Diagnosing a Plantar Plate Tear


Your doctor will move and manipulate the troubled toe joint into several different positions to evaluate the amount of deformity and the location of the pain. X-rays show the degree and angles of the deformity, as well as any arthritis in the joint. In some cases, a special x-ray with a dye is injected into the joint to find the tear in the ligament. MRIs are also used to evaluate the extent of damage to the plantar plate ligament.


It is important to distinguish the areas of pain on the ball of the foot from neuroma (pinched nerve), which presents similar symptoms.  Read more about neuromas here.



Plantar Plate Tear treatment options


Conservative care

In the early stages of the disruption of the ligament, conservative treatments can be successful. The first step is to identify the activity that is causing the injury and stop doing it.


In acute cases, your doctor will prescribe a special shoe or boot to take weight off the ball of the foot. Special tape will be wrapped around the toe to hold it in a downward position for several weeks. If there is any deformity from side to side, the tape can hold the toe in the opposite direction. This allows the ligament to heal without continued strain.


Custom molded orthotics may also be prescribed.  Orthotics with support under the ball of the foot alleviate pressure off the overstretched area and keep the deformity from returning.


Surgical care

When there is a severe deformity, surgical correction is indicated. The toe is realigned into the joint and stabilized by tightening the plantar plate tear. This procedure is done from the top of the joint, the plantar plate tear is identified and repaired. If the metatarsal bone is long or the hammertoe is contracted, the bones are repositioned to align the foot and decrease abnormal pressure through the region. Occasionally, the plantar plate may be very badly damaged and not reparable. In such cases, the flexor tendon from the bottom of the toe is wrapped around the top of the toe to hold the toe in joint. No loss of function is noted with this flexor tendon transfer.  No pin is used in order to avoid arthritis and allow early physical therapy.


This surgery is similar to the correction of a hammer toe deformity, where a tendon transfer is needed to reconstruct the torn plantar plate area. A pin is used to hold the area during healing and a boot is worn for 5-6 weeks. With proper care, patients return to full activity with little to no pain. If left untreated, the toe will often dislocate and a more involved surgery is necessary to correct the problem.



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