First off, I’m sorry. Second, you need to get sure. A plantar plate tear is a tear in the ligaments that make up the ball of your foot. This is where your arch and toes meet. It can be difficult to assess if you actually have a plantar plate tear without a ton of experience, an MRI, or a really good doctor. I can help some.
First some basic symptoms. Well, there’s pain. Plantar plate tears tend to have specific locations where they centralize. The most common one in my experience is right where the arch and the ball of the foot meet. There’s usually a little lump or ball there for each toe. In all three of my plantar plate tears that was my most painful spot. I could REALLY feel this area when walking and when I would touch it with my hand it was incredibly sensitive. Plantar plate tears don’t have to be centralized there though. You can feel them further up, heading towards your toes. I would commonly feel pain below the surface on the sides of my metatarsal (toe bones).
Pain in this area can be difficult to pin down a culprit. Doctors are exponentially more likely to diagnose you with a neuroma or possibly a stress fracture. The quickest test to see if you should never see a doctor again is if they say you have metatarsalgia. This is the medical term for pain in the pain on the bottom of the foot. It literally tells you nothing at all. Kindly thank them for their time and rapidly walk out of their office.
A neuroma is when a nerve or bundle of nerves gets inflamed and starts going haywire. It can hurt just as bad if not worse than a broken foot. Neuromas are pretty common in this area so they get their name put on top of a baking soda volcano made by a plantar plate tear far too often. If you wear tight shoes, like pointed heels, or something narrow like track spike, your toes get squished together. The nerves in between your toes do not appreciate this and neuromas can form. neuromas can also form from trauma/injury. Neuromas can feel like a tiny marble of pain somewhere in your foot.
It can be extremely difficult to self-assess the difference between a broken toe, neuroma, and a plantar plate tear. If you can’t figure it out, an MRI in front of an experienced foot doctor is the best bet.
A plantar plate injury will often lead to one or more of your toes rising up off the ground. A hammertoe or claw toe, where the middle knuckle of the toe is starting to curl upwards is a telltale sign as well.
If you do have some plantar plate dysfunction is will usually hurt to pull the toe upwards, in a dorsiflexed manner, since you’re tugging on that damaged ligament.
There is also a common test of putting a piece of paper under the impacted toe and seeing if the patient can plantarflex their toe into the ground and stop the paper from being pulled out from under them. So someone needs to lightly be pulling the paper. Once the plantar plate ligaments get really damaged it becomes very difficult to plantarflex the toes down and stop the paper from being pulled out. This is an okay test. It is definitely still possible to stop if with a grade 1 or 2 tear though. It can be used in comparison to the opposite side to see how much loss of function has occurred.
As far as differentiating a plantar plate tear from a neuroma… it can be tough. I have found that since neuromas are more nerve based and a plantar plate tear is more of a ligament and structural injury, neuromas tend to be more spastic. Meaning, you will have good days and not know why. It is harder to figure out when a neuroma is going to flare up and make you cry. A plantar plate tear will typically feel better the more you stay off of it and the more cushion you put under it. Walk around too much, or spend to much time barefoot and it will let you know pretty quickly.
If the pain isn’t too unbearable you can usually follow a taping protocol and get some better-cushioned shoes and a plantar plate tear can clear up in as little as 4-6 weeks. If that didn’t do the trick for you and the pain is getting worse, it might be time to get an MRI and start looking for a foot specialist with plantar plate experience. Not just with neuromas!
I would STRONGLY advise making sure whoever you seek medical attention from has experience working with these types of injuries. Foot issues get misdiagnosed ALL THE TIME. A misdiagnosis can set you back on the road to recovery and cost you a lot more money.