Plantar Plate Repair

What is plantar plate repair? 

A plantar plate injury is when damage occurs to the strong supporting ligament of a toe, located on the ball of foot. The plantar plate is a thick structure that provides significant stability to the toe. Any to can be damaged, but the most commonly affected to is 2nd toe. Plantar plate injuries can be acute or chronic. 

Causes: Plantar plate injuries tend to occur from the sudden and excessive upwards motion of the toe. The toe can dislocate and ‘pop’ back into place, and it is common for bruises to appear with severe injuries. A plantar plate tear can render the toe unstable, and there’s potential to develop into a hammer toe if it’s not treated.

Sign & Symptoms: Symptoms of a plantar plate tear include

• a dull ache or sharp pain in the ball of the foot.
• a feeling that there is not enough cushion between the foot bone and the ground can also occur.
• possible swelling and/or redness on the foot near the toe.

Diagnosis and Treatment: The first step to assessing plantar plate injuries involve the use of Weight bearing x-rays. In some cases, the joint is injected with a special dye to find the tear in the ligament via a special radiographic x-ray.

Both acute and chronic plantar plate injuries can be repaired with surgery. Specific treatments depend on the extent of injury to plantar plate ligament, cause of tear, time from injury, the presence of a toe contracture (hammer toe), and the overall biomechanical foot structure.

 The basis for plantar plate tear surgery involves sewing the ligament (plantar plate) back together in the proper position to repair the tear. Simple tears are straightforward. A complex tear usually involves a shredded plantar plate and requires special plastic surgery techniques to get the ligament ends together. Severe tears where the plantar plate is pulled off the bone involves using a special bone anchor secure the ligament to the bone.

Chronic plantar plate injury surgery is more complex than an acute injury. The problem with chronic injuries is that secondary compensations of the toe may have set in, making repair of the plantar plate secondary to a larger, unidentified problem. Usually plantar plate repair for chronic injuries necessitate supplementary procedures to balance the affected toe, especially if the toe is dislocated or buckled.

Recovery: The full recovery time after direct repair of the plantar plate is about four to eight weeks. Because a plantar plate is a thick ligament that requires time to fully heal, there is no way to speed up the healing process. Patients need to be off the affected foot while the repair heals, and crutches or walkers are commonly necessary. The foot can be placed in a surgical shoe, removable boot, or cast depending on the severity of the repair.