In mild cases, there might be no apparent deformity to the toe and a patient may experience either a dull ache or sharp pain. As the plantar plate tear increases over time, the toe will shift up and/or to either side. In these more severe cases, dislocation of a toe at the metatarsophalangeal joint may cause excessive pressure on the metatarsal head.
The plantar plate is a ligament on the underside of the forefoot between the base of the lesser 4 toes and the associated metatarsal bones that they attach to. The plantar plate keeps the toe in the metatarsophalangeal joint, especially with walking as the toes bend while pushing off the ground. In cases of injury, the ligament tears or becomes overstretched either thru overuse or from a single traumatic episode. This may cause pain and can eventually lead to toe dislocation.
In early stages of ligament disruption, diagnosis may be obtained via a combination of clinical evaluation and imaging. Your doctor may perform a Lachman test to evaluate the integrity of the plantar plate. The extent of the injury may also be determined by ultrasound or MRI if there is significant pain or hammertoe deformity.
For acute cases, we generally prescribe a boot or special shoe to limit bend of the forefoot. We can perform special taping that should remain on the toe for a variable number of weeks. This taping aligns the affected toe into a downward position, while also correcting any abnormal sideways drifting. This allows the ligament to heal without facing continued strain.
Custom orthotic devices are often a good first step since they support the front of the foot and assist in preventing the deformity from recurring.
In mild to moderate cases (such as a partial plantar plate tear), Orthobiologic Treatments such as Platelet Rich Plasma, or Shock Wave Treatment may facilitate healing of the ligament. The aim of using Orthobiologics is to support your body’s self-healing processes, reverse disease progression and suppress inflammatory reactions that can worsen pain, leading to symptom relief and recovery of function. We utilize Regenerative Medicine procedures including your own cells to repair the plantar plate naturally.
In the rare cases of chronic and severe deformities that have failed conservative measures or if there is a compete plantar plate tear, surgery is recommended. As the plantar plate is tightened and repaired, this will stabilize the joint and realign the toe.
Although Orthobiologic Cell Therapy is considered by some people to be experimental, various research studies show that some marrow aspirate concentrate and platelet rich plasma injections may provide excellent relief from joint and musculoskeletal pain and ongoing inflammation.