Plantar Plate Tear Treatment Options
Posture Podiatry Adelaide Podiatrists often see clients complaining of pain in the ball of the foot. A common cause of this type of ball of foot pain can include a plantar plate tear. There are certain plantar plate treatment options that should be considered before surgery.
What is plantar plate pain?
Plantar plate pain can be described as pain under the ball of the foot caused by injury, overload or excessive stress of the plantar plate ligaments. It can feel like you have a bruise under the ball of the foot which is usually exacerbated by weight-bearing activities. It’s also a fairly common sports injury, especially in sports where jumping, landing and pivoting are involved such as netball, football, soccer, basketball and dancing.
What is the plantar plate?
The plantar plate is a thick ligament that connects the long bones of the foot (metatarsals) to the corresponding toes (proximal phalanges). It helps provide protection to the toe joint capsule and the metatarsal heads. It protects the ball of the foot from excessive pressure, prevents the toes from spreading apart and stabilises the metatarsophalangeal joint. It also provides an insertion point for the plantar fascia, enabling the toes to plantarflex towards the ground when standing.
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What are the symptoms of plantar plate pain?
Symptoms may be characterised by some of the following:
- Feeling like the ball of the foot is bruised
- Swelling through the lesser toe joints under the foot
- Pain through the ball of the foot or on top of the foot when weight bearing
- Increased pain when on tip toes, jumping or higher heeled shoes.
- Increased pain when walking barefoot compared to walking with shoes
- Pain with extension or bending the toes upwards.
If the plantar plate is completely torn, the base of the toe may start to deviate from the normal position enabling a hammer toe to develop.
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What are the causes of plantar plate pain?
The cause of pain can be anything that exposes the toe joint (metatarsophalangeal joint) to repetitive and excessive stress. This can include:
High impact activities that involve a lot of jumping, running or pivoting such as football, soccer, ballet/dancing, sprinting and netball. Runners that are forefoot strikers can also be more prone to experiencing plantar plate pain. Others suffering with bunions or arthritis may also be predisposed to plantar plate injury. Traumatic injury can also cause plantar plate pain such as landing from a significant height.
Biomechanical factors can also predispose people to plantar plate tearing and injury. Any biomechanical abnormality that increases the load through the lesser toes will expose those joints to increased forces which may result in plantar plate pain.
A bunion, or hallux abductovalgus, will restrict the function of the big toe increasing load through the lesser toes. In the more severe stages, the bunion itself will also place an increased load on the plantar plate. A very pronated, or flat foot can restrict the big toe’s ability to extend, leading to propulsion and extension through the lesser toes. This can also contribute to injury and pain in the plantar plate region.
A high arched foot (supinated or cavus foot) can also experience more excessive forces and increased load through the forefoot especially in the presence of excessively tight calf muscles. Plantar plate pain or injury may also be seen in this situation.
Deterioration of the natural fatty padding underneath the ball of the foot (plantar fat pad atrophy) tends to occur naturally as we age. If you can feel the bones underneath the foot quite easily, you may have plantar fat pad atrophy. This degeneration of the padding leads to increased loads through the plantar plate ligaments and can also be a causative factor.
Finally, any blunt trauma directly to the plantar plate can cause injury and pain. Although uncommon, falling from a height or landing heavily on uneven ground or rocky terrain may be the cause of your plantar plate pain.
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What are the differential diagnoses of plantar plate pain?
Any pain that affects the ball of the foot can have a number of different causes. They can be all very similar in symptoms and in location, so it can be difficult to determine the exact cause without an accurate examination. However, our experienced Adelaide Podiatrists will be able to give a diagnosis pairing symptoms with subjective history and objective findings. Sometimes imaging is needed to confirm the diagnosis.
Some of the different possible causes include:
- Neuroma
- Bursitis
- Joint capsulitis
- Synovitis
- Metatarsal stress fracture
- Plantar fat pad atrophy
Our podiatrists can help you determine the true cause of pain so treatment is specific to individual needs.
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What’s the best plantar plate pain treatment?
There are many different treatment options for plantar plate pain and, depending on the severity of the pain, may impact the treatment choice and management recommendations by your Podiatrist.
Strapping and Padding
Taping of the foot and toes may help to reduce load temporarily. This may be combined with specific padding to help reduce forces on the ball of the foot in the region of any plantar plate injury or pain. Taping can help provide some immediate relief before applying more permanent treatment.
Plantar Plate Tear Exercises
Specific stretching and strengthening exercises may be needed. If calf muscles are tight, stretches may be needed. These exercises may be combined with strapping and some strengthening exercises of the intrinsic flexor muscles of the foot if appropriate.
Footwear Review
There are many types of footwear that would be suitable to help offload the ball of the foot. Sneakers are a great choice, as there’s lots of width and depth in the forefoot, enabling the foot to function without excessive compression or tightness. Also, sneakers have great cushioning so they help provide a stable but soft base for the forefoot.
A rocker-soled shoe is ideal choice for plantar plate pain as the shoe will help to actively propel you forward during gait rather than relying on the force exerted by the ball of the foot. This drastically reduces the load on the ball of the foot and the plantar plate region. A shoe with a heel is best avoided as this will only further increase the load on the ball of the foot.
For dressier shoes, it’s best to visit specialty shoe stores and try on shoes to ensure the fit is correct. Posture Podiatry has a range of Adelaide shoe stores we can recommend to help find just the right shoe.
Foot Mobilisation
Joint stiffness or immobility at some joints will usually cause increased demand for movement at other joints. It’s important to ensure the joints of the feet and ankles are functioning correctly as any restriction at the ankle joint may well increase the demand for toe joint extension. This increased load on the toe joints can be reduced with appropriate foot mobilisation if needed.
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Orthotics
Orthotics are a tool that a podiatrist can use to help reduce load on the ball of the foot. The purpose of an orthotic is to redistribute load through the foot more evenly. If you have a biomechanical abnormality that is increasing load through the forefoot, then the use of an orthotic will function to offload the forces going through the ball of the foot.
Specialised Orthotic Modifications
Additions to the standard orthotic prescriptions can also be used to further offload the ball of the foot. Plantar plate tear orthotics may utilise a U-pad extension which can help to offload a single plantar plate.
A metatarsal dome may be more appropriate and could well be utilised to reduce pressure off two to three plantar plates if positioned correctly just proximal to the metatarsophalangeal joints. If positioned incorrectly, pain can be exacerbated so it’s important to assess the painful foot accurately and position the domes accordingly.
A metatarsal bar is another useful tool which can also help to redistribute pressure away from the painful area. A metatarsal bar may be used when the plantar plate pain is affecting more joints.
In some instances, a rigid insole may be utilised to prevent flexion of the forefoot. This works best in a rocker-soled shoe, as we can gain propulsion through the shoe rather than the force created by the foot.
Extracorporeal Shock Wave Therapy
For plantar plate pain that is starting to become chronic, that is the pain which is over 6 months old, shockwave therapy can be a helpful option. Shockwave therapy is a treatment that is unique to Posture Podiatry as not many other Podiatrists have access to it. It helps to increase blood flow to targeted areas, aiding the healing process.
The plantar plate is not very vascular so by increasing blood flow and promoting tissue repair, healing can take place when combined with other appropriate pressure relieving treatments. A course of extracorporeal shock wave therapy (ESWT) often involves 3 treatments, spaced 7 to 14 days apart. All Posture Podiatry Adelaide Podiatrists are trained in using the ESWT machine and can potentially help you resolve pain faster.
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What is a Plantar Plate Tear?
A plantar plate tear is a more serious plantar plate injury. It occurs when the plantar plate ligament actually tears off either the metatarsal or toe. This tear can cause the toe to sit in a funny shape or in an odd direction – which may cause even further issues such as hammer toes, corns and calluses. They can also be much more painful and debilitating than just plantar plate pain in the acute stages and cause more toe malalignment over the longer term.
Plantar Plate Tear Treatment
Treatment for plantar plate tears is similar to that applied with plantar plate pain but will also often utilise special crossover taping for plantar plate tears to help keep the toe in a relatively normal position.
If all conservative treatment options fail to relieve the pain from a plantar plate tear, surgical options may then be recommended. Surgery on plantar plate tears can be very effective and achieve successful outcomes, but it can require offloading the foot for up to 12 weeks so it’s worth considering conservative management prior to surgery.
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BOOK ONLINE for an Initial Low Gap or Gap Free* Assessment
or Call 8362 5900 to schedule an “Initial Low or No Gap* examination” to see if we can help.
