Plantar plate tear

Last revised by Yuranga Weerakkody on 13 Jul 2022

Plantar plate tears are disruptions of the metatarsophalangeal joint (MTPJ) plantar plate(s). They are essentially a form of metatarsophalangeal joint capsular tear, and most frequently occur at the distal lateral aspect of the plantar plate.

Plantar plate tears can be broadly divided into involving the hallux/great toe/first toe and termed turf toe or sand toe, or the lesser metatarsals/toes 2-5, and termed plantar plate tears 1,7

Presentation can be acute or chronic and can be associated with other joint conditions such as rheumatoid arthritis. Patients may present with metatarsalgia and/or deformity in cases of full-thickness plantar plate tears.

In the lesser metatarsals, increased weight-bearing load and hyper-extension forces placed on the MTPJs by high-heeled, pointed shoes are thought to be possible predisposing factors.

  • dynamic maneuvers with ultrasound can demonstrate discontinuity of the normal plantar plate
  • partial-thickness tear:
    • following acute trauma, focal edema in an aspect of a plantar plate suggests low-grade sprain or tear, without discontinuity 7
  • full-thickness tear:
    • discontinuity
    • proximal retraction
    • persistent hyper-extension of the proximal phalanx 1, or valgus/varus deviation of the toe
  • indirect features of a plantar plate injury
    • metatarsophalangeal joint synovitis
    • flexor tendon sheath tenosynovitis
    • pseudoneuroma sign 8
    • plantar plate - proximal phalanx distance >2.75 mm 8

Clinical differential considerations include

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4: Full-thickness tear
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