Plantar Plate sprains (also known as Plantar Plate Tears) are common, painful conditions that can affect runners of all ages and experience levels.

What is a Plantar Plate Sprain?

A sprain is a torn ligament.  Sprains occur in varying degrees of severity:

  • Grade 1 Sprain describes a ligament that was overstretched which results in microtears and ligament laxity.
  • Grade 2 Sprain is defined by partial tearing of the ligament resulting in more severe pain and possibly, partial joint deformity.
  • Grade 3 Sprain is a complete tear of the ligament and results in intense pain with obvious joint deformity.

Since Plantar Plate Sprains come in varying degrees they are sometimes difficult for doctors who do not specialize in diagnosis and treatment of the disorder to identify and diagnose accurately.

Plantar Plate Sprain Symptoms

Runners will typically describe intense pain near their 2nd through 4th toes in the ball of the foot that gets worse while walking or running. If you have pain beneath your 2nd, 3rd or 4th metatarsal, and it gets worse with walking, jumping or running, you may have a Plantar Plate Sprain.  In the early stages of the injury it is most likely a Grade 1 Plantar Plate Sprain, which can be treated quickly and effectively using conservative methods.  You will know if the injury has progressed if your pain gets worse or you develop a limp following activity.

Plantar Plate Sprain Diagnosis

Dr. Allen can perform a thorough orthopedic examination of your foot to accurately diagnose the condition and differentiate it from other conditions, such as:

Differentiating these conditions is actually quite simple with proper manual, orthopedic testing. If there is still doubt after a thorough examination an MRI can be used to differentiate the disorders. San Diego Running Institute has brokered cash deals with private, local San Diego MRI facilities for those that have either no MRI coverage or catastrophic deductibles that often prevent them from obtaining proper care or treatment.  The average cash fee for an MRI is only $500. X-rays can be performed the same day as the examination and do not require a scheduled appointment whereas an MRI can usually be performed within a couple of days.

Plantar Plate Sprain Treatment

The course of treatment depends on the severity of the tear. Grade 1 and Grade 2 Plantar Plate Sprains are treated with excellent outcomes at the San Diego Running Institute.  Grade 3 Plantar Plate Sprains are more severe and will not typically respond to conservative treatment and may require surgery.

How To Fix A Sprained/Torn Plantar Plate Ligament

We never want to tell a runner to “Stop running”, but that is exactly what we have to do in most cases of a Plantar Plate Sprain.  In mild cases we successfully treat the condition by placing Plantar Plate supports on the runner’s insoles of the shoes they wear most often.  We also use waterproof athletic tape to align the joint to ensure maximum and effective healing.  Therapeutic Ultrasound is applied to stimulate blood flow into the largely avasucular Plantar Plate Ligament. Simple exercises are prescribed to stimulate blood flow and promote strengthening of the deep intrinsic muscles of the foot.

Severe Grade 1 sprains and Grade 2 Plantar Plate Sprains usually require a stiff bottom walking boot for the runner to wear for six to twelve weeks depending on the severity of the sprain.  This ensures that the patient is not flexing, bending or stretching the damaged Plantar Plate, and thus allows for complete, maximum healing.  During the time period the patient is required to wear the boot there is a therapeutic protocol consisting of Ultrasound, taping and exercises that is also undertaken.

Surgery to Correct Torn Plantar Plate

Plantar plate surgery should only be considered if conservative treatment methods fail.  It should be your last resort in most cases.  We have found that 90% of patients treated with conservative methods do not require surgery, and they are able to return to normal, pain free running.

Torn Plantar Plate – Custom Orthotics

We often use custom orthotics to treat plantar plate pain, but they are not a perfect solution. The custom orthotic will most likely be ineffective if:

  • The custom orthotic is not crafted correctly
  • The plantar plate support is not placed precisely
  • The injury is not addressed and given time to begin the healing process

It is our experience that after the injury is healed and the person resumes normal pain free activity a custom orthotic can be made to prevent future recurrences of the injury.  San Diego Running Institute makes our own custom orthotics on site which helps keep the costs below average ($367) and gives us complete control in the construction of the orthotic.  These are a great alternative to those made in orthotic labs; they often create hard, rigid orthotics that actually make the condition worse.

Healing Plantar Plate Sprains

If all of the correct procedures are followed there is no reason to expect anything less than 100% resolution of the condition.

Fibrin

By supporting and/or immobilizing the Plantar Plate, usually for a period of 6 weeks to 3 months, the ligament will heal by forming new tissue know as Fibrin.  The new fibrotic tissue will essentially from a “patch” over the damaged area of the Plantar Plate.  This new fibrotic tissue will at first be stiffer and may result in feelings of “tightness” beneath the Metatarsals.

Macrophages

Over the period of the next few months, even up to a year, the feelings of stiffness and tightness will lessen due to specialized cells in your body called Macrophages.  These cells will reshape and reorganize the fibrotic tissue molding it as close to perfect as possible. It is our experience that making custom insoles with Plantar Plate supports provides additional protection to the area while it undergoes remodeling and strengthening and are a viable addition in the prevention of future recurrences.

Medical Journal Articles About Plantar Plate Pain

Forefoot pain is one of the most common presenting problems in a foot and ankle practice. One of the most common presenting problems, yet most commonly missed problems, is a plantar plate tear. Often the problem is considered to be potential neuroma, fat pad atrophy, or a generalized diagnosis of metatarsalgia or metatarsal head overload. Unfortunately, not enough attention is placed on the plantar and medial/lateral ligamentous structures of the metatarsal-phalangeal joints. This lack of attention results in poor diagnosis, lack of care, treatment for the wrong condition, and ultimate frustration for the patients and doctor.
 
“Plantar plate tears: a review of the modified flexor tendon transfer repair for stabilization.”
– Originally Published by National Library of Medicine (NLM) in Jan, 2011.
OBJECTIVES:
To determine the optimum position of a metatarsal (MT) pad to treat metatarsalgia.