Plantar Plate Pathology
Plantar Plate Pathology
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The plantar plates are deep ligaments that form the bottom part of the joint capsule within each of the joints in the ball of the foot. The plantar plates help to stabilize the foot and toes when weight bearing and also provide the attachment of the plantar fascia into the base of the toes.
Repeated micro trauma can lead to tearing or partial tearing of the plantar plate. If left untreated this could cause deformity of the affected toe.
Patient Signs and Symptoms
Patient Signs and Symptoms
Tenderness and palpable oedema within plantar aspect of metatarsophalangeal joint (commonly affects 2nd toe)
Occasional neurotic pain due to localised irritation of plantar digital nerves as result of oedema
Lump or bruised feeling under metatarsophalangeal joint
Feeling of walking on a stone
Barefoot walking and tip toeing uncomfortable
Significant Findings
Significant Findings
Progressive hammer toe deformity
Dorsiflexion usually pain free, plantar flexion often very painful.
Positive Vertical stress test
Association with Hallux Valgus
Association with long 2nd metatarsal
Associated Findings
Associated Findings
Mechanical (shortened 1st ray, disorders of Hallux, inefficient metatarsal parabola)
Inflammatory Arthritis
Osteoarthritis
Local joint Instability
Gout (blood screening required)
Sudden increase in activity
Change in footwear
Imaging
Imaging
Not indicated at initial assessment unless history of trauma or to suspect osteomyelitis, however x-ray has low sensitivity and specificity for detecting acute osteomyelitis.
Imaging maybe used at later date, can be discussed at our MSK Podiatry Virtual Escalation clinic as required on presentation.
Preferably weight bearing views in lateral, Dorsal/ Plantar and Oblique.
Differential Diagnosis
Differential Diagnosis
Stress fracture/fracture
Avascular necrosis (Freiberg’s infraction)
Synovitis
Plantar Digital Neuroma
Degenerative joint disease
Rheumatology/inflammatory arthritis (blood screening required)
Heloma durum
Ulceration
First line treatment options
First line treatment options
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