What is the plantar plate?
The plantar plate is a deep fibrocartligenous structure in the foot that attaches to the proximal phalanx and the metatarsal head . The role of the plantar plate is to keep the toes in place by stopping them from drifting apart or over extending, therefore injury to this can cause significant impairment.
Relevant anatomy
When considering the possibility of pathology within the plantar plate, it is important to
understand the local relevant anatomy to help with differential diagnosis and how the injury may
impact the individual.The plantar plate arises from the plantar fascia and inserts inferiorly onto the proximal phalanges from the corresponding metatarsal head. The plantar plate sits superficially to the toe flexor tendons, and the deep transverse ligaments attach plantar plates together by connecting the metatarsal heads. The collateral ligaments also sit either side of the plantar plates.
How is the plantar plate injured?
The plantar plate can be susceptible to tears, whether they are partial or incomplete. These can
be caused by a range of issues but are commonly caused by chronic overload, such as lots of
walking, age or trauma. The tear then causes a discontinuity of the fibres of the plate, which
results in pain for the individual and an associated drifting of the toe.
How is a plate plate tear diagnosed?
A plantar plate tear is often initially diagnosed through a clinical assessment from a
Physiotherapist, Podiatrist or Foot Surgeon, but then further imaging such as ultrasound or an
MR scan will be indicated to confirm the diagnosis.
How is an injured plantar plate treated?
A plantar plate tear will often require some form of intervention from a physio, podiatrist or foot surgeon.
Conservative management is often preferred in the initial stages. Such management may involve
● Strapping of the toes to reduce drifting
● Activity modification to avoid painful activities
● Changing footwear
● Orthotic prescription to provide padding for the affected toes
● Non steroidal anti inflammatories are sometimes prescribed to help reduce any
inflammation and pain .
However, it is important to recognise that such management may take some time to settle the
pain and can often take 2-4 months.
In some cases, conservative management won’t suffice and surgery may be indicated to repair
the tear in the plantar plate