Understanding Plantar Plate Injuries



Plantar Plate Injuries

Plantar plates are fibro-cartilaginous structures of the lesser metatarsophalangeal (MTP) joints. These are composed of type 1 and type 2 collagen fibres, providing resistance to tensile forces and acting as a cushion to absorb compressive loads.

Caio Nery, from the Orthopaedic and Traumatology Department of the Federal University of São Paulo, provides a detailed description of the anatomy of plantar plates in his study published in Seminars in Musculoskeletal Radiology.

Extending from the plantar aponeurosis, the plantar plate and deep transverse ligaments are attached to the dorsal capsule of the MTP joint and extensor hood by the accessory collateral ligaments, which insert into the lateral aspect of the plantar plate.

With the distal most portion of the plantar plates firmly attached onto the base of the proximal phalanx, this type of an anatomic arrangement is responsible for restricting the dorsiflexion of the proximal phalanx.

The accessory collateral ligaments, combined with the deep transverse intermetatarsal ligament, impart stability in the transverse plane.

The flexor tendons, located in the inferior surface of the plantar plates, act as primary flexors of the interphalangeal joints across the MTP joint, providing dynamic stability of the digits in the sagittal plane.  

Chronic injuries to the MTP joint such as hyper-extensive forces consistently delivered to the joint, can cause the stabilising structures of the plantar plate to deteriorate and the first MTP joint to become unstable and dislocate.

An excessive dorsal displacement of the proximal phalanx on the metatarsal head is observed in pathologic conditions of the MTP joints, because of the inability of the weakened plantar plates and the intrinsic flexors in pulling the proximal phalanx into a neutral position during gait.

A multitude of conditions such as hallux valgus, cavus foot, metatarsalgia, plantar fasciitis can be linked to lesions or tears in the plantar plate which are caused by an increase in peak pressure of the associated metatarsal, most commonly the second metatarsophalangeal joint.

Orthotic intervention helps in the offloading of additional pressure from the affected metatarsals, providing stabilisation to the metatarsophalangeal joints and reducing stress to the plantar plates.

MASS4D® orthotics help prevent inflammation or ruptures of the plantar plates while supporting the correction of any underlying biomechanical abnormalities such as hypermobility of the first ray that could potentially cause further deviation of the metatarsophalangeal joints.

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References:

  1. Nery C., Umans H., Baumfeld D. (2016) Etiology, Clinical Assessment, and Surgical Repair of Plantar Plate Tears. Seminars in Musculoskeletal Radiology: April 2016, Vol. 20, pp. 204-212
  2. Maas G. M. N., Van der Grinten M., Bramer M. W., Kleinrensink G. (2016) Metatarsophalangeal joint stability: A Systematic Review On The Plantar Plate Of The Lesser Toes. Journal of Foot and Ankle Research: 2016, Vol. 9, No. 32, DOI 10.1186/s13047-016-0165-2
  3. Baravarian B. (2016) Expert Insights On Treating Plantar Plate Tears. Podiatry Today: March 2016, Vol. 29, No. 3, Retrieved from: http://www.podiatrytoday.com/
  4. Nery C., Coughlin J. M., Baumfeld D., Raduan C. F., Mann S. T., Catena F. (2014) Classification of Metatarsophalangeal Joint Plantar Plate Injuries: History and Physical Examination Variables. Journal of Surgical Orthopaedic Advances: November 2014, Vol. 23, No. 4, pp. 214-223

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