The plantar plate is a deep fibrocartilaginous structure which originates from metatarsal heads and attaches to the proximal phalanx through the joint capsule within the forefoot

Functions of the plantar plate

  • Stabilize the metatarsophalangeal joint
  • Assist in the windlass mechanism due to its attachment to the plantar fascia
  • Resist hyperextension of the metatarsophalangeal joint and absorb compressive loads

Plantar Plate Tear
Tears of the plantar plate most commonly happen under the second metatarsophalangeal (MTP) joint, though it can occur at any of the metatarsophalangeal joints. It is also referred to as a pre-dislocation syndrome, crossover toe deformity, and floating toe syndrome.

The plantar plate is a deep fibrocartilaginous structure which originates from metatarsal heads and attaches to the proximal phalanx through the joint capsule within the forefoot

Functions of the plantar plate

  • Stabilize the metatarsophalangeal joint
  • Assist in the windlass mechanism due to its attachment to the plantar fascia
  • Resist hyperextension of the metatarsophalangeal joint
  • Absorb compressive loads

Plantar Plate Tear

Tears of the plantar plate most commonly happen under the second metatarsophalangeal (MTP) joint, though it can occur at any of the metatarsophalangeal joints.  It is also referred to as a pre dislocation syndrome, crossover toe deformity, and floating toe syndrome.

Indications of Surgery

  • Painful plantar plate injury that does not respond to conservative treatment

 

Alternative to Surgery

  • Footwear modification
  • Activity modification
  • Custom-designed orthotics
  • Padding in the shoes
  • No treatment

 

What does surgery involve

  • Day procedure
  • An incision on the top of the foot between metatarsal bones
  • Shorten affected metatarsal bone (Weil Osteotomy)
  • Anatomical repair of the plantar plate

 

Risks/Complications

  • Floating toes
  • Transfer metatarsalgia (pain in the adjacent bone)
  • Recurrence of the deformity
  • Continued pain
  • Non-union(bone not healing), delayed union(bone takes a long time to heal): 0-2%
  • Wound dehiscence
  • Nerve damage
  • Joint stiffness
  • Infections(soft tissue/bone)
  • Prolonged swelling
  • Scar sensitivity
  • Deep vein thrombosis/Pulmonary embolism

 

How long does the operation take?

  • The operation usually takes approximately 60 minutes.

 

Is this a day procedure?

  • Yes, you can usually go home the same day.

 

Will I have a plaster cast?

  • But you will be given a postoperative shoe to wear for 4-6 weeks.

 

How long will I need off work?

This will depend on the job you do and the speed of your recovery.

  • Sedentary jobs: 2 weeks
  • Standing/walking jobs: 6-8 weeks
  • Manual/labour jobs: 8 weeks

 

What will happen afterwards?

  • Your first appointment is usually scheduled between 5-7 days
  • Stitches removed between 10-14 days
  • For the first 2 weeks, you should avoid walking if possible and only put your weight through your heel
  • When not walking, rest with your foot elevated to reduce swelling
  • You should be able to walk comfortably within 2 months but some swelling may last up to 12 months
  • You may start high impact exercise after 3 months

 

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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