Plantar Plate Tear Treatment in Beverly Hills

What is a plantar plate tear?

On the bottom of the ball of the foot at the level of each lesser toe, there is a thick and strong ligament called the plantar plate. It attaches to the base of the bone of the toe (phalanx) and the long bone of the foot (metatarsal) across the joint. Its job is to secure the toe in a straight position within the joint and relocate the toe when it bends in normal walking. The ligament is named for its shape like a plate.

Spraining or tearing with direct trauma or repetitive trauma over time can damage the plantar plate. It usually occurs at the 2nd toe joint. It is sometimes referred to as predislocation syndrome.

Symptoms of a Plantar Plate Tear

  • Pain in the ball of the foot

  • Pain when bending the toe up or down

  • Deviation of the toe towards another toe

  • Elevation of the toe

  • Leads to the formation of a Hammer Toe

  • Pain with walking and activity

  • Swelling in the ball of the foot

  • Pain in high heel shoes

Causes of a Plantar Plate Tear

The plantar plate ligament can sprain, partially tear, or rupture. These can occur with repetitive microtrauma over time or direct trauma to the structure. It is usually caused by a negative mechanical influence on the joint. Poor anatomy of the foot can also lead to plantar plate tears.

  • High arched foot type

  • Long metatarsal

  • Bunions

  • Hammer Toes

  • Hyper upwards flexion of the toe

  • High impact sports

  • High heel shoes

How is a plantar plate tear diagnosed?

Diagnosis is achieved by the clinical examination and x-rays of the patient taken in our Beverly Hills office. Dr. Soomekh will listen to the patient’s complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot and evaluating their gait. Digital radiographs (x-rays) of the feet will be obtained in the office and reviewed with the patient. A specialized CT scan of the foot may be obtained to evaluate the metatarsal bones in 3D to aid in diagnosis. Diagnostic ultrasound of the ligament will be performed to directly evaluate the ligament and will be reviewed with the patient. An MRI may be ordered to further evaluate the ligament.

Plantar Plate Tear Treatment

Early diagnosis and treatment of a plantar plate tear is paramount. It can take several weeks and months for a plantar plate to heal depending on the amount of damage to the ligament. Those with a plantar plate tear need to be patient during the healing process. Cortisone injections are NOT recommended.

The plantar plate is difficult to heal because:

  • It has poor blood supply

  • Its location on the bottom of the foot is under constant strain

  • There is repetitive bending of the toe, stretching the ligament when walking

Treatment with no deformity of the toe:

  • Ice therapy

  • Anti-inflammatory medications

  • Rest

  • Splinting / Taping the toe in a downwards position

  • Stiff-soled shoes

  • Custom Molded Orthotics

  • Physical Therapy

Treatment with deformity of the toe:

  • Walking boot

  • Platelet-Rich Plasma Therapy

  • Surgical repair of the ligament: Hat-Trick

Dr. Soomekh has perfected and reinvented these surgical procedures and techniques for the treatment of a plantar plate tear and is recognized by his peers as one of the top foot and ankle specialists in Beverly Hills and the Los Angeles area.

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David Soomekh