Plantar Plate Rupture

Most commonly experienced by middle aged women, a plantar plate rupture is often a cause of persistent pain and swelling in the forefoot. It is also commonly associated with a bunion and a hammer toe. The plantar plate is a thick ligament type structure with attachments which inserts into the base of our phalanges (toe bones) in the area of the ball of the foot. The plantar plate is designed to protect the head of the metatarsal from pressure and prevent over extension of our toes. It also plays a role in preventing our toes from spreading or splaying.

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Causes

  • Trauma
  • Altered foot mechanics
  • Prolonged standing (occupation related)
  • ‘Wear and tear’

Diagnosis

Diagnosis of a plantar plate tear can often be challenging due to the complex nature of the anatomy of the foot. Careful history taking and an examination of the area of pain is required to determine the extent and cause of the tear. If necessary, further investigations such as x-rays or diagnostic ultrasound may be ordered by Dr Kim to help evaluate the severity of the problem. A positive Lachman’s test is usually indicative of a plantar plate rupture

Conservative Management

Initial treatment of the tear will focus on symptom relief. This may involve the use of anti-inflammatory medications, strapping of the toe, off-loading padding, altered footwear and activity modification. Following this treatment will focus on the underlying causes of the problem, such as flat feet, bunions and hammer toes. Dr Kim will perform a thorough assessment to determine the best course of action to offload the forefoot and decrease the mechanical stress on the area. This injury usually occurs gradually and is best treated in the early stages. Often, orthotic and footwear modifications can prevent the problem from progressing

Surgical Management

  • Direct repair of the ruptured plate
  • Weil osteotomy
  • Metatarsal head resection

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner

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