Plantar Plate Injury

🦶 Types & Key Insights

The plantar plate is a fibrocartilaginous ligament located on the plantar aspect of the metatarsophalangeal (MTP) joints, primarily beneath the second toe.
It serves as a static stabilizer, maintaining joint alignment and preventing excessive dorsal displacement of the toe.

Plantar Plate Tear
- A common injury characterized by a disruption in the plantar plate ligament, often due to repetitive stress or acute trauma.
- Symptoms include pain at the MTP joint, swelling, and possible toe deformities.
Turf Toe (Hallux MTP Joint Injury)
- An injury to the plantar plate of the first MTP joint, typically resulting from hyperextension of the great toe.
- Common in athletes, especially in sports requiring sudden starts and stops.
Lesser Toe Plantar Plate Injury
- Affects the plantar plate beneath the second to fifth toes.
- Often presents with pain, swelling, and possible deformities such as hammertoe or mallet toe.
Bunion-Associated Plantar Plate Injury
- Occurs when a bunion deformity (hallux valgus) leads to increased stress on the second MTP joint, potentially causing a plantar plate tear.
- Symptoms may include pain and instability in the second toe.

Clinical Tests:
- The "drawer test" is utilized to assess the stability of the MTP joint and the integrity of the plantar plate.
Imaging:
- Ultrasound and MRI are effective in visualising tears and assessing the extent of injury.

Conservative Management:
- Rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
- Custom orthotics to offload stress from the affected joint.
- Ribbon or Buddy taping or strapping to stabilise the toe.
- Rocker soels
- Carbon plate
Surgical Intervention:
- Indicated in cases of complete tears or when conservative measures fail.
- Procedures may include plantar plate repair or reconstruction.

Early diagnosis and appropriate treatment are crucial for optimal outcomes.
Untreated injuries can lead to chronic pain, joint instability, and progressive deformities.