Plantar plate dysfunction/Predislocation syndrome and Tear
Definition
Plantar plate dysfunction and tear has become increasingly more common since the onset of the fitness revolution. This is not to say that couch potatoes are immune to this painful foot problem. Plantar plate injuries are most often the cause of a low grade repetitive stress rather than a traumatic incident. This type of injury can be attributed to both the structure and the function of the foot.
The plantar plate is a thickened, fiberous part of the metatarsal joint capsule underneath the joint that attaches to the base of the toe. It functions in stabilizing the metatarsophalangeal joints, prevents hyper-extension of the toes (excessive dorsiflexion) and to allow the ball of the foot to withstand the excessive tension and compression of weight-bearing and impactful activities.
Signs and Symptoms
Signs of plantar plate dysfunction include swelling and redness around the painful joint and dislocation of the toe dorsally (hammering) or splaying of the toes (medial or lateral dislocation).
Symptoms pain in the ball of the foot that worsens with extension of the joint during heel off and forefoot loading when walking or running.
Diagnosis
The diagnosis of plantar plate dysfunction or tear can be tricky. Neuroma, capsulitis, and sesamoiditis can also create similar symptoms. The Lachman Test can help differentiate plantar plate injuries by grasping the toe and pushing it upward. The toe should not dislocate, but if it does the amount of dislocation will be evidence of the severity of the condition.
Treatment
Conservative treatment includes orthotics, splinting the toe down, immobilization, rest, non-steroidal anti-inflammatories and High Power Laser Therapy.
Surgical treatment would require repair or possible grafting of the plantar plate depending on the severity.
