Plantar Plate Rupture

"There's a pain on the sole of my foot and the toes are swelling."

"My toes are moving apart and they are painful when I walk"

The plantar plate, like any structure in the body, is something nobody thinks about, until it goes wrong.

There is a ligament that holds all of the metatarsal heads together across the forefoot and there are small sections at the head of each of the metatarsals that fasten the metatarsal to the phalanx - the bone at the base of the toe. This is the plantar plate.

If this plantar plate tears, the two bones are able to move independently of each other. Apart from pain, a sign that this has happened is that the foot swells and the toes move away from each other. Sometimes the toe lies lower than the other toes, other times it moves to the side and may even overlap the next one. The pain is often described as a dull ache.

Very commonly, this tear affects the second toe (the one next to the big toe) and is caused by trauma - commonly a history of tripping up.  People with long second toes and very short big toes are more prone than others and those living with Hallux Valgus (bunions) are also more likely to rupture the plantar plate. Individuals who have diabetes or arthritis are also in the 'high risk' group.

Your podiatrist can usually diagnose this problem without  the use of an x-ray and the treatment for it may not involve surgery. A simple diagnostic test involves moving the two bones to analyse how much movement is present. Sometimes this is called, 'Subluxation'.

The aim of treatment is to realign the toe, which may be achieved through taping the joint. A strong tape is passed from the metatarsal head, around the affected toe and back to the affected joint. This forms a type of sling which supports the structures in the absence of the plantar plate. Padding is often used to complement the strapping which will  relieve the painful joint, avoiding pads which allow the joint to point towards the floor.

The role of biomechanics cannot be stressed too highly when dealing with a plantar plate rupture. As the tear usually occurs as a result of the natural architecture of the foot in combination with other predisposing factors, an orthotic will aid in supporting the foot whilst healing and lower the risk of it all happening again.

If you have a swollen foot and a pain like a dull ache in the metatarsal area of your foot, you may well have a plantar plate rupture, so seek professional advice as soon as you can!