Planter Plate Tears of the Lesser Toes Introduction The plantar plate is a type I collagen ligamentous structure that supports the plantar aspect of the metatarsophalangeal joint.
Planter Plate Tears of the Lesser Toes The plantar plate is a type I collagen ligamentous structure that supports the plantar aspect of the metatarsophalangeal joint. The plantar plate resists loads that occur with dorsiflexion of the toes and also help to cushion and support the MTP joint. An intact plantar plate is necessary to ensure the proximal phalanx does not sublux from the joint and to avoid the development of pain or rigid hammertoe deformity.
Injuries to the plantar plate can be both acute and chronic. Anatomy of the plantar plate Diagnosis Diagnosis of a plantar plate is considered when a patient complains of forefoot pain. The differential for forefoot pain includes a Morton’s Neuroma, stress fracture, Freiberg infraction, and capsular degeneration.
Clinical evaluation will identify a swollen MTP capsule, a floating toe, or a medially displaced toe. Gapping between the toes indicates a plantar plate tear and usually occurs in a medial direction. Physical examination should also include a drawer test to assess for joint laxity.
A Mulder's maneuver should also be done to rule out a Morton's neuroma. A paper pull-out test can also be done to assess for any weakness with plantarflexion, which can be seen with a plantar plate tear. Proximal phalanx drawer test First line imaging includes an AP, lateral, and oblique radiograph.
Radiographs can evaluate for toe gapping or MTP joint subluxation. Widening between the second and third phalanx, seen on the AP x-ray, is called a V-sign. An ultrasound evaluation of the MTP joint can also be used to identify tears within the plantar plate.
If you are experiencing symptoms that may be related to plantar plate tear of the lesser toes, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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