PlantarPlateTearPlantarplatetearsareacommoncauseofpainontheballofthefoot.Whatistheplantarplate?Theplantarplateisaligamentousstructurewhichliesbeneaththemetatarsophalagealjointsofthelessertoes.Thissupportsthejointsduringwalkingandactivity.
Howdoestheplantarplatetear?Theplantarplateusuallytearsatitsinsertiontotheproximalphalanx.Itcantearwithatraumabutmorecommonlyittearsinassociationwithdegeneration.Thesecondtoeisthemostcommonlyaffected.Whatarethesymptomsofatear?• Painbeneaththemetatarsalhead.• Deformityofthetoeeitherclawingor
splayingofthetoesduetothelossofthesupportingfunctionoftheplate.
• Rubbingoverthetoeduetodeformity• Painandswellingoverthetopofthe
metatarsophalangealjointduetoinflammation.
• Numbnessinthewebspace.
Howisthediagnosismade?• Historyandexaminationisthemost
importantandimagingisconfirmatory• Xrays• UltrasoundorMRIscanningWillthetearhealonitsown?Thetearoftenoccursindegeneratetissueandisunlikelytoheal.Thepainmaysubsideover6months.Ifadeformityofthetoehasdevelopedthiswillnotcorrect.Whatarethenonoperativetreatments?• Simplepainrelief• Activitymodification• Shoemodification–deeptoebox• Orthotics-Metatarsaldomeorbar• Toesplint
Whatisthesurgicaltreatment?Surgeryconsistsofrepairingthetearbackdowntotheproximalphalanxwithsutures.Thisrequiresanincisiononthetopofthefoot.Themetatarsalboneiscut(Weilosteotomy)toallowexposureandreducethesofttissuetension.Thisisfixedwithascrewaftertheplatehasbeenrepaired.Additionalsurgerytofusethetoemayberequiredifafixedhammertoedeformityispresent.
Whatdoestherehabilitationinvolve?• Youareinhospital1night• Forthefirst2weeksyoushouldkeepyour
feetelevatedasmuchaspossibletominimizeswelling
• Youareabletobeginweightbearingimmediatelyinastiffsoledshoe.Thisshoeistobewornfor4-6weeks.
• Physiotherapybeginsat2weekstooptimisethemovementinthetoeandtopreventscarring.Tapingmayberequired.
• By4-6weeksyoucanbeginwearingwideoropenshoesandshouldbecomfortablewalkingaroundyourhouse.
• By3monthsyoushouldbebacktomostactivitiesandwearingyournormalshoes.
• Swellingcantakeupto6monthstoresolve.RecoverytimesmaybelongerifadditionalsurgeryisperformedWilltheoperationbepainful?Youroperationwillusuallybedoneundergeneralanaesthetic.Toprovideongoingpainreliefyouranaesthetistwillperformanerveblockwhilstyouareasleepwhichnumbsthefootfor8-16hours.Sowhenyouwakeupyouwillhaveminimalpain.Astheblockwearsoffyouwillbegivenoralpainrelief.
HowlongwillIbeoffwork?Thisisdependentuponyouroccupation
• Seatedjob 3-4weeks• Standingjob 6-8weeks• Heavyliftingjob 8-12weeks
WhencanIdrive?IfyouhaveamanualcaryouwillbeunabletodrivewhilstinthepostopshoeIfyouhaveanautomaticcaryoucandriveafter2weeksifyouhaveyourleftfootcorrectedandwhilstinthepostopshoeifyourrightfoothasbeencorrected.Whataretherisksoftheprocedure?Generalrisksofsurgery• Infectionandwoundhealingproblems• Nerveinjuryandscarsensitivity• Bloodclotstotheleg• Anaestheticproblems• Incompleteresolutionofsymptoms
Specificrisksforplantarplatesurgery• Stiffness• Recurrenceofdeformity• Underorovercorrectionofthetoe• OsteotomynothealingThisinformationisanoverviewofthemanagementofplantarplatetearsandisnotallinclusive.IfyouhaveanyquestionsregardingthispleasecontactMr.Curry’sroomson(03)99286188