OPA!!! Did you “break” your plantar plate?

Plantar PlateMany patient’s present to my office complaining of “ball of foot pain”.  Many things can be occurring in the wonderfully complex forefoot, and many times, we are able to differentiate pa theologies based on the description of symptoms.  One particular issue which I am seeing more and more of is something that many people have never heard of; the plantar plate rupture.

The plantar plate is a cup like ligament that provides support to the plantar aspect of the metatarsophalangeal joint (or the bottom of the joint connecting the toe to the long metatarsal bone associated with it). This provides stability to the joint, and helps prevent dorsal dislocation when walking and running.

The plantar plate can sometimes suffer injury. This can be the result of a direct trauma, but I more often see it as a result of repetitive stress or “wear and tear”. These injuries are often associated with an elongated metatarsal. Over time, the ligament frays and weakens, eventually leading to attenuation or rupture. This will lead often lead to a toe deviating to the side. Most commonly, I see this occurring to the 2nd or 3rd metatarsophalangeal joint.  An MRI or detailed musculoskeletal ultrasound is often extremely helpful in evaluating the damage to the plantar plate, and in differentiating plantar plate pathology from other forefoot pain such as neuromas.

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