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