What Is a Plantar Plate Injury?
A plantar plate injury refers to damage to the strong supporting ligament of a toe, located on ball of foot. The plantar plate is not an ordinary ligament as it’s a thick structure that provides significant stability to the toe. Most commonly the second toe is involved, but any toe can be damaged. Plantar plate injuries can be acute or chronic. Read more about Plantar Plate Repair!
Symptoms & Causes of A Plantar Plate Injury
Patients can sustain an acute plantar plate injury where the ligament in torn or can develop a slow tear.
Acute Injury: Symptoms of acute injury to the toe can be pain and swelling depending on just how the injury occurred. Injuries tend to occur from sudden and excessive upwards motion of the toe. Sometimes this can be an explosive injury or a small injury from excessive walking. A tearing sensation can be felt in some people. The toe can dislocate and ‘pop’ back into place. Bruising is common with severe injuries. A plantar plate tear can render the toe unstable, and if not treated develop into a hammertoe problem.
Chronic Injury: A chronic plantar plate injury is very different than an acute injury. Here the plantar plate (ligament) will have micro-tears and stretch out over time. A chronic injury can occur from a trauma where the initial plantar plate tear was undiagnosed – this is best considered a non-healing injury. Alternatively, a chronic injury of the plantar plate may occur from a biomechanical imbalance to the foot where repetitive stress causes repeat tearing. Chronic (or nonhealing) plantar plate injury can develop into a hammertoe. Pain is often present on the ball of the foot, and the toe may become severely deformed.
Diagnosis of Plantar Plate Tear
Diagnosing plantar plate injuries can be challenging for a variety of reasons, which will be outlined. Acute injuries where there is obvious instability of the toe with pain located on the ball of the foot (directly) over the plantar plate are straightforward. However, most injuries are subtle – whether acute or chronic.
There is a maneuver to test the integrity of the ligament but is often unreliable. This test is called a Lachman’s test, which is orthopedically known as a drawer test. Here the toe is lifted superiorly to see if the joint can be manually dislocated. Obvious cases are obvious, of course. Mild and moderate displacement is a gray zone.
X rays have limited utility as ligaments can’t be visualized. However, surgeons can ascertain information about the joint alignment which can suggest a plantar plate injury. Toe dislocations are usually obvious (and uncommon) but are indicative of a plantar plate injury.
Magnetic Resonance Imaging (MRI) is very helpful with plantar plate injuries as it’s non-invasive and allows for direct visualization of the plantar plate. However, MRI is not perfect, and small or mild tears can be missed or poorly identified – even by the most experienced.
An arthrogram is the best way to determine the integrity of the ligament structures (plantar plate) surrounding the joint. The test is invasive, however. A needle is inserted into the joint and radiographic dye is injected to see if any fluid leaks out. An arthrogram will not indicate severity, only integrity. Cited www.apma.org
When to Seeking Treatment
If you’ve been searching for podiatric surgeons for your foot and ankle needs, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today
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