Plantar Plate Injuries

Injuries to the plantar plate across the ball of your foot is a common pain we see that stops active Wairarapa locals in their tracks. It is most commonly felt beneath the second or third toe joints and is most prevalent in runners, dancers and those that spend lots of time on the balls of their feet, putting the force of their body weight (or even many times their body weight when running or jumping) on these joints.

Your plantar plate is at the balls of your feet

Each of the joints at the balls of your feet is surrounded and protected by a joint capsule. The plantar plate is a thick tissue that sits at the bottom of the joint. It starts just before the joint (towards the midfoot) and connects to the joint, where it’s the thickest, and then up to the toes. Due to its location here, pressure is placed on it with every step you take.

The plantar plate helps you in many ways. It:

• Helps prevent your toes from being pushed too far upwards (hyperextending)
• Stabilises the toes
• Helps prevent toe deformities like hammertoes
• Helps you push up off the ground during walking and running
• Helps the fat pad beneath the ball of your feet absorb the compressive forces you incur when you walk, run or jump
• Helps prevent our toes from separating too far from one another (which would negatively impact the way we walk and make us more vulnerable to pain

How plantar plate injuries occur

Plantar plate injuries and tears occur when the forefoot, and hence the plantar plates, are repeatedly overloaded, meaning excess pressure or force is placed on the balls of the feet. The second toe is the most common site for this, though any toe can be affected. This overloading may occur from:

• Physical activities where you spend more time on the balls of your feet, e.g. dancing, running
• A job or activity where you’re regularly climbing stairs
• Having flat feet or other problems or irregularities with your foot posture
• The effects on your feet from having a bunion or other toe deformities (claw toes, hammertoes, mallet toes)
• Walking for prolonged periods on hard surfaces like concrete, or in hard, unsupportive footwear
• Having a longer second toe, or a shorter big toe, may also make you more vulnerable to plantar plate injuries

Signs & symptoms

If you’ve injured your plantar plate, you may experience:

• Pain and swelling directly beneath a joint at the ball of the foot
• Worsening pain when the toe is pushed upwards (dorsiflexed) towards the sky
• A ‘V’ sign (toe separation) between the affected toe and the one next to it 
• The feeling of walking on the bones of the feet

Treating plantar plate injuries

In our experience here in Masterton Foot Clinic, the earlier we are able to diagnose and start treating your plantar plate injury, the better and faster we can get you back to moving without pain. 

The first step is to help you get relief from your pain so you can feel more comfortable on your feet. We can do this by using specific strapping techniques on your toes, as well as using temporary padding to relieve pressure away from the affected joints.

Next, it’s essential to address the causes of your plantar plate tear, so that the injury doesn’t worsen during this vulnerable time, it can heal effectively, and that the problem doesn’t recur in the future. This often involves using custom foot orthotics to help correct any biomechanical or alignment issues that may have contributed to the injury, like foot posture. They will keep your feet in a more optimal position for healing and repair, while supporting healthy, stable gait. 

We have found shockwave treatment to help speed up our patients’ recovery from plantar plate tears by promoting your body’s healing and repair of the damaged structures, Masterton Foot Clinic is the only clinic in the area to offer this innovative treatment to support our patients’ recovery.

We’ll also check your shoes to make sure they’re helping your recovery and not making it worse. We’ll discuss any associated problems like bunions and how this may be affecting your injury and your feet, and assess whether a rehab program for tight or weak muscles and tissues, if present, can be beneficial for you.

In severe cases, a splint or boot may be required to offload the forefoot completely. 

Frequently Asked Questions

Can plantar plate injuries cause long-term complications?

Without proper treatment, plantar plate injuries can lead to chronic instability, deformities, and ongoing pain.

Is surgery always necessary for plantar plate injuries?

Not at all. Surgery is reserved for severe cases or when conservative treatments fail to provide relief – and we don’t see these all too often. Most mild to moderate cases are managed effectively without surgery.

Can I prevent plantar plate injuries?

You can reduce the risk by wearing supportive footwear, avoiding excessive high heels, and using proper techniques in activities that involve the feet.

Is physical therapy beneficial for plantar plate injuries?

Absolutely, physical therapy can be highly beneficial for strengthening the foot, improving flexibility, and rehabilitating the injured plantar plate.