Plantar plate tear
Plantar plate tear is seen in a broad spectrum of patients. However for some reason its usually most often seen in ladies in their 30s and 40s. It is also commonly seen in highly active men and women who perform high impact sports such as running, tennis, hill walking and netball.
Video of the mechanics of a plantar plate tear
Plantar plate tear anatomy
The plantar plate comprises of a broad ligamentous structure with attachments which inserts into the base of our
phalanges (toe bones) underneath the foot. See picture.
The plantar plates job is to;
Protect the metatarsal head from pressure
Prevent over extension of our toes.
To prevent the toes from splaying or spreading.
The causes of plantar plate tear
Poor biomechanics is the leading cause of plantar plate rupture. Over pronation causes instability in the forefoot leading to unwanted stress being placed on the plantar plate leading to a tear in its structure.
Trauma to the foot . A single traumatic event can lead to plantar plate tear.
Overuse of the foot. Plantar plate tear can occur due to high physical stress on the foot due to activities such as running, jogging or hill walking.
Poor shock absorbency. Increased shock loads through the foot due to lack of shock absorbency in footwear can increase the chances of plantar plate tear.
plantar plate tear Symptoms
A dull ache is often noted under the ball of the usually (but not always) under the 2nd toe.
Swelling under the ball of the foot extending into the toe/ toes.
Swelling may also be visible on the top of one of the lesser toes making it appear 'fatter' than the 
others.
Often the most obvious symptom is a 'daylight sign'. The patient notices that the toes have splayed and there is an obvious gap between one toe and the other. As is seen on the x-ray.
Plantar plate treatment
R.I.C.E
Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping. | |
| Ice - Place a plastic bag with ice on the foot for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications. |
| Compression - Lightly wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold. |
| Elevate - Make sure to elevate the ankle above heart level. | |
Ice packs and compression bandages are excellent to reduce pain and swelling
Plantar plate tear treatment - to restore normal function
Once the acute symptoms have settled down do nothing for 3-4 weeks to allow the plantar plate to heal.
Once the healing process has taken place it is necessary to rehabilitate the affect leg.
Eccentric exercises
| Technique: | Sit with your knee straight and hold the foot position as long as possible. Do as frequently as possible for the first 3-10 days. |
| Pullback
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After 10 days
Plantar plate treatment - Eccentric exercise 2
The stretching exercises require the use of a theraband which is a strong elastic band.
| Technique: | Hold each exercise 30seconds at a gentle stretch. Do not bounce! |
| Frequency: | 3 sets 10 repetitions/exercise, 5-7 days per week progressing to 3 sets of 15 |
| Begin eccentric exercise program 7-10 days after pain has subsided
Warning:There should be no pain when doing this exercise. If there is stop! |   |
Below is a video showing the uses for the rehab band (whole body).
Calf stretches
Why calf stretches?
Tight calf muscles are one of the leading causes of overloading of the forefoot. This can lead to plantar plate tear and is often overlooked.
| Technique: | Hold each exercise 30seconds at a gentle stretch. Do not bounce ! |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week
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Perform a toe raise on a 4-6 inch box or step with both legs. Once on your toes, lift the uninvolved leg and lower yourself slowly into dorsiflexion (heel down, toe up).
Warning:There should be no pain when doing this exercise. If you feel pain in the plantar plate, stop! |   |
Plantar plate tear - hamstring stretches
Why stretch the hamstrings when the plantar plate is the problem? Tight hamstrings causes the knee to stay flexed throughout the gait cycle. This has the 'knock on' effect of overloading the front of the foot by causing early heel lift in the gait cycle. Tight hamstrings are one of the major causes of this problem that goes undetected.
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Hamstring Stretch | |
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To stretch the hamstring place the leg on a flat surface (like a bed or sofa) as in the image above. Image here shows use of an ice pack. This is NOT needed if the hamstring isn't injured. 1.Keep leg straight. 2. Knee against the surface 3. sit up straight slowly. 4.You will feel the hamstring start to pull. 5.Once you can feel this gentle pull, hold for 30 seconds and relax. 6.Repeat 10 to 15 times per day. If you feel pain stop! | |
Plantar plate treatment - muscle strengthening exercises
Foot muscles -strengthening
To have the best chance of a rapid recovery it is a good idea to strengthen the muscles in the foot, ankle and legs. This will help to take unwanted stress off the plantar plate structures. The single best exercise to improve strength of the muscles around the foot ankle is eccentric loading. This is usually done none weight bearing, however the use of a wobbleboard is an excellent way to strengthen muscles around the foot and ankle in a controlled and gentle manner. It also has the added benefit of improving proprioception too. Proprioception is the nerve connection from the brain to the foot. This is often damaged/ disrupted after injury and can increase the chances of injury from recurring. It can also significantly delay recovery.
Plantar plate tear - prevention
Golden rule- Don't ignore the problem, it won't go away! If you have been afflicted by this injury it is virtually certain that you will have another attack sooner rather than later.
The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family).
The is the cheapest and most cost effective way for any athlete to reduce the risks of injury from occurring and to prevent re-injury is follow our checklist below. Overall costs for the average athlete will run into pennies per mile/hour of sport.
1. Check your footwear
Are your running shoes worn and in need of replacing? If so change them. Plantar plate tear can be caused by high impact forces so a good shock absorbing shoe is a must. For more advice on running trainers our running shoe advice page is worth reading. Read more->
Below are a selection of trainers that are ideal for athletes.
Trainers for a neutral or under pronating foot type
Trainers for over pronators
2. Rectify poor biomechanics with orthotics if necessary
The way your foot strikes the ground and the forces that are placed on it can have a direct effect on causing a plantar plate tear and can also delaying healing times. Check our biomechanics page for detailed information. Read more->
Bespoke Orthotics
Think you require bespoke orthotics for your plantar plate symptoms? Visit our sports podiatry clinic pages for a clinic near you.
3. Strengthen weak foot and ankle muscles
Wobbleboard exercise is a great way to strengthen foot & ankle muscles and help prevent plantar plate tear.
4. Improve shock absorbency.
Plantar plate tear can be made worse by high impact forces being directed through the forefoot, particularly in running activities. Purchasing some shock absorbing insoles is a cheap and effective way of vastly improving shock absorbency. and reducing unwanted ground reaction force. These little pads slip into the shoe and are not noticed by the athlete when partaking in sport.
Plantar plate tear injury prevention checklist summary
Plantar plate tear returning to sporting activity
With plantar plate tear, the goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your plantar plate recovers, not by how many days or weeks it has been since your injury occurred.
After suffering from a plantar plate tear, you may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
You have full range of motion in the injured foot compared to the uninjured foot.
You have full strength of the injured foot compared to the uninjured foot.
You can jog straight ahead without pain or limping.
You can sprint straight ahead without pain or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
Getting professional advice
If self treatment is not working or you are concerned regarding the severity of your condition it is always wise to gain a professional opinion. A good sports podiatrist is your best option preferably a clinic that is affiliated with other members of the multi- disciplinary team such as physios, sports rehab instructors etc.
However consultation fees can be expensive. If you are an athlete who needs regular treatment we highly recommend a healthcare plan. it will cover physio, podiatry and even dental bills and you can get cover for a few pence per day, for the whole family if need be. We recommend 'Simply health' to our patients as cover is comprehensive and cost effective.
Plantar plate tear surgery
Below is a video showing a plantar plate rupture repair. Warning graphic content!