One of the most common forefoot complaints that presents to my FootDr podiatry centres is a plantar plate tear. This is seen most frequently in middle-aged women who present with constant plantar metatarsal pain and swelling extending towards the toes (mostly affecting the 2nd toe). Often swelling and redness can also be noted across the dorsum of the forefoot along with symptoms exacerbated by extended periods of walking or running and the use of high heel shoes. As the plantar plate tear progresses, clawing and splaying of the toes is seen.
Early diagnosis and management of a plantar plate tear can often be challenging due to the complex structure and anatomy of the foot. If necessary, furthe
r investigations can be ordered such as plain x-ray or diagnostic ultrasound to appraise the severity of injury. However, the early stages of a plantar plate tear are best managed when there is only acute plantar metatarsophalangeal joint synovitis and no instability or deformity (clawing and splayed toes). Conservative treatments primarily include symptomatic relief through NSAIDs, strapping, off-loading padding, footwear and activity modification. Subsequently treatment will then focus on the underlying cause of the problem ie pes planus, bunions, hammer toes, mechanical stress. At myFoot Dr podiatry centres we will perform a thorough physical and biomechanical assessment to determine the best course of action to offload the forefoot and decrease mechanical stresses. Often a customised, soft, CAD/CAM orthotic device and footwear modifications are recommended that can prevent the problem from progressing.
Occasionally in chronic cases, an orthopaedic appraisal and surgery is recommended. Generally, most patients are able to return to activity in 1 month of treatment and pain free within 3-4 months.