Treatments for Plantar Plate Tears
Published November 30, 2021.
The plantar plate is the fibrocartilaginous ligament in the ball of your foot that supports the toe joints and keeps them in place. When there is repetitive overloading of the head of the metatarsal, a plantar plate injury can occur.
What Is a Plantar Plate Tear?
A plantar plate tear is a common injury that affects the forefoot. It refers to the tear of the plantar plate ligament and is most common at the second toe. Sometimes, it may be confused with a plantar fascia tear which is direct damage to the small fibers of the plantar fascia. However, the two affect different structures though they may cause similar symptoms.
The repeated trauma causes the connective tissue running across the toes to stretch or tear. These plate tears can cause pain and swelling in the ball of the foot, dislocation, and even toe deformity, making walking difficult.
In this article, we'll discuss various causes and risk factors of plantar plate tears, their symptoms, treatment, and duration of recovery, depending on the treatment.
Symptoms of a Plantar Plate Tear
A plantar plate tear is a common cause of forefoot pain in athletes, yet, it's often misdiagnosed. To receive prompt treatment, it's essential to recognize the symptoms. Aside from causing forefoot pain, it may also cause a burning, tingling, or numb sensation between the toes and on the ball of the foot after standing for a long time. Shortly after the tear, there may also be swelling and redness at the top of the foot.
Causes and Risk Factors of Plantar Plate Tears
Any action that places the ball of the foot under considerable strain repeatedly can cause a plantar plate tear. Some of these factors include:
- Ill-fitting shoes or high-heel shoes.
- Having a long second metatarsal bone
- Presence of a bunion or a hammertoe
- Barefoot walking
- High-impact activities like dancing, running, and jumping.
- Gait abnormality (e.g. rolling feet inwards while walking)
- Repeated bending of the toes
- Cortisone injection
What Happens if a Plantar Plate Tear Goes Untreated?
Plantar plate tears can be a significant source of foot pain. Unfortunately, it's unlikely to recover without intervention because it occurs in degenerate tissue. Correct diagnosis and treatment are essential to managing forefoot pain.
While conservative treatment will cause full recovery in patients with mild tears, a surgical procedure may be necessary for more advanced tears. Without treatment, plantar plate tears could cause significant pain and deformity of the foot. It could also cause midfoot pain, hammertoes, crossover toe deformity, arthritis, and other debilitating foot conditions.
Home Treatments for Plantar Plate Tears
When a plantar plate tear occurs, treatment is necessary to guarantee a good prognosis. In the acute phase, conservative treatment is very effective.
The home treatments include rest, ice, taping, splinting, orthotics, and padding. Generally, the goal of intervention at this point is to relieve pain, promote healing, and remove any activity or force that can lead to deformation. Approaches can include:
Non-steroidal anti-inflammatory drugs (NSAIDs) can help in managing pain. However, these are not as effective in the acute phase of plantar plate tears.
Toe Splints or Pads
A toe splint keeps the toe in its proper position while healing occurs after partial tears. You can splint the toe in a basket weave fashion. While toe splints maintain the alignment of the toes and prevent deformity, toe pads reduce physical irritation and pressure on the ball of the toes, easing pain and discomfort.
Taping is the initial treatment for plantar plate tears. The aim is to keep the toe in a plantarflexed position while limiting dorsiflexion during walking. To do this, tape the affected toe downwards in a basket weave fashion.
Ideally, you should be deliberate about the type of shoe you wear as it can impact the healing process. The best shoes for plantar plate tears should have a strong metatarsal pad, a deep toe box, a cushioned sole, and a supportive arch. These components will help to immobilize the plantar plate and relieve any pressure and pain from plantar plate tears.
A metatarsal dome or bar can be designed to support the front of the foot and assist in preventing deformity. More specifically, custom orthotics redistribute body weight, redirecting the weight away from the ball of the foot to the foot arch. As such, they keep the pressure off the injury when walking, allowing healing to occur.
Immobilize in a Moon Boot
A moon boot, otherwise known as a Controlled Ankle Motion (CAM) boot is an orthopedic boot for treating and stabilizing sprains, fractures, and tears in the ankle or foot. It can be used to immobilize the feet after a plantar plate tear to allow healing. Unlike casts, Moon Boots can be adjusted, reused, and even removed. In some cases, it may be used for as long as 6-8 weeks.
Running with a Plantar Plate Tear
Running overloads the plantar plate. As such, it may worsen a plantar plate tear, leading to permanent damage and making it more painful. However, it may be impossible to stay away from running completely as an athlete. In that case, orthotics may be used to cushion the effect and redistribute the body weight to the foot arch.
Also, exercises like lunges, calf raise, and box jumps must be avoided as they can worsen a plantar plate tear.
Exercises for Treating Plantar Plate Tears
While there are dangerous exercises for plantar plate tears, there are also exercises that may be performed for treating the tears. These exercises will aid in the healing of the plantar plate and promote faster recovery from foot injuries.
However, exercises can only commence after the initial pain has resolved. The goal of the exercises is to strengthen the intrinsic muscles of the foot. Some of the exercises that are effective for plantar plate tears are:
This exercise will strengthen the intrinsic foot muscles. To carry it out:
- While in a standing position, place your feet flat on the floor.
- Slowly glide up your greater toes, increasing your medial foot arch in the process.
- Repeat as much as 200-300 times daily.
Lesser Toes Flexion Exercise
Like the toe push-up, the lesser toe flexion exercises strengthen the intrinsic foot muscles too.
- Place a resistance band around your lesser toes keeping your hand firmly at 90 degrees.
- Slowly flex your lesser toes against the resistance band while keeping the force from the band constant.
- Once lowered, hold and then slowly lift the toes back up.
- Repeat 10-15 times for the foot. If the foot lowering becomes too easy, increase the resistance by pulling the band tighter.
Balance Exercises Using a Wobble Board
- Begin by standing on the wobble board with your feet hip distance apart.
- Stand upright and maintain a neutral spine, focusing straight ahead.
- Shift your weight so the board edges can’t touch the floor.
- Hold that position for 30 seconds.
Calf raises may be considered if the pain has subsided in the ball of the foot, and you can use the highest resistance band on toe flexion. Perform calf raises for plantar plate tear as follows:
- Stand with the balls of your feet on the edge of a stair or step.
- Push your heels up as far as you can.
- Slowly lower the heels until your heels are just below the top of the step or stair. Return to the starting position once you feel a stretch in your calf muscles.
What Is the Plantar Plate Tear Recovery Time?
The healing time depends on the severity of the tear and how prompt treatment begins. Generally, you can expect that you should have returned to normal activities after 3 months. However, sometimes it may take up to 6 months for swelling to resolve.
When to Consider Plantar Plate Surgery
Surgery may be considered in both chronic and severe cases of plantar plate tears. For example, a stiff toe or a toe that remains painful and deformed after non-conservative treatment are both indications for surgery. There may also be a need to realign the toe and stabilize the joint.
Depending on the aim, the doctor may employ different surgical techniques to repair the plantar plate tear, correct the toe deformity, and relieve pain. The method depends on the extent of injury to the plantar plate ligament, cause of tear, time from onset of injury, presence of a toe deformity, and general structure of the foot.
Your medical provider will advise you on the best course of action
Plantar Plate Surgery Recovery Time
Following surgery, the patient will not be allowed to bear weight on their foot for a recommended period of 4-6 weeks. The foot must be allowed adequate time to heal.
If you start weight-bearing on your foot too early, it may increase the chances of re-injury. Additionally, changes in your foot structure may require you to get new orthotics to reduce the impact of activities on your foot.