The plantar plate is an area under the ball of the foot on the bottom of the joint capsule that encapsulates the joints of the lessor toes. It is a strong ligament structure that provides stability to the joint and serves as an attachment area of other ligaments that surround the joint. Sometimes that thickened ligament can get overused, which typically gets termed plantar plate dysfunction. Sometimes it can progress to a small rupture in the structure and can become very painful to walk on. This is called a 'plantar plate tear'. It is a reasonably common musculoskeletal problem of the foot.
Usually, it is painful under and just in front of the metatarsal heads to walk on and when the area is palpated. When standing the toe of the affected joint is usually slightly elevated. There are some specific tests or movements that clinicians can do to the toe to test the integrity, function and strength of the plantar plate and to determine just how bad the tear is. The cause of a plantar plate tear is not often very obvious, but there are a number of risk factors that do increase the chances of getting it, but mostly is it due to too much use with too much dorsiflexion of the toe. An unusual sensation that some with this problem describe is a feeling of their sock scrunched up under the toes, but when they check its not.
The best way to treat a plantar plate tear is to get the diagnosis correct. It is obvious clinically. An ultrasound examination can be used to determine the extent of the tear and confirm the diagnosis. The usual initial treatment approach is to use taping for a plantar plate tear which is designed to hold the toe in a plantarflexed position to limit the amount of dorsiflexion of the toe when walking. A metatarsal pad that is placed just behind the painful area can also be useful to help relieve the strain. A stiffer or more rigid soled shoes or shoes with a rocker can also be used to help limit the strains on the toe. If this is done correctly, the plantar plate tear should generally heal up over time. An alternative to taping is using the the Fix Toe device as it is a more practical approach than having to keep tape or strapping on the toe. If this does not help then a surgical repair of the tear is indicated.