Plantar plate tears are incredibly common and too often go undiagnosed. In Layman’s terms, the plantar plate is a fibrous structure made up of ligaments that runs under the ball of your foot. The plantar plate connects your plantar fascia (arch) to your toes. When you put weight on the balls of your feet, that pressure is being absorbed by the plantar plate and some of the bones in your feet. Since the ball of your foot region takes so much force, it is quite easy to overload the plantar plate. As the plantar plate gets beaten down, the ligaments start to weaken, microtears occur and pain is felt on the ball of the foot. Since the plantar plate attaches the toes to the rest of the foot, as it is weakened the toes become less stable. Often hammertoes, claw toes, or just a general upward raising of one or more of the toes can be attributed to some sort of damage to the plantar plate region.
TLDR: A plantar plate tear is the weakening, tearing, and breakdown of the ligaments that attach your toes to your plantar fascia. This ligament runs under the ball of the foot and that is generally where the pain is felt. Plantar plate tears are EXTREMELY common and are frequently misdiagnosed as metatarsalgia, stress fractures, stress reactions, synovitis, stone bruise, and many more.
Doctors and podiatrists are not all well versed in the plantar plate are of the foot. Often time when a patient comes in with ball of foot pain, doctors will try to diagnose it as almost any other condition besides a plantar plate injury. You will see people being told that they have metatarsalgia, a stone bruise, a neuroma, a stress fracture, when far too often they have structural damage to their plantar plate.
One study using diagnostic ultrasound and MRI on 40 asymptomatic feet and 40 symptomatic feet detected plantar plate tears in the asymptomatic feet at a rate of 46.8 percent and MRI detected tears at a 34.3 percent rate.31 In the symptomatic patients, plantar plate tears were present at a rate of 86.8 percent as detected by ultrasound and a rate of 88.7 percent detected by MRI.
That means 46% of people that did not even have pain in the ball of their foot had some sort of tear in their plantar plate. This reveals that even without much pain, those ligaments in the ball of your foot can start to break down before you notice. This is partly due to the fact that the nerves in your feet aren’t as receptive as other nerves in the body. Years of walking, running, and jumping deadens the nerves on the bottom of your feet. There is also not a lot of blood flow in certain parts of your feet. This is another reason why you might not notice the pain before it is too late. Lack of blood flow also makes it much more difficult for certain injuries in the feet to heal. Blood contains red blood cells that carry oxygen. Oxygenation is one of the most crucial parts of healing. So not only will you more than likely notice your plantar plate tearing after the fact, it is going to be more difficult to heal.
Plantar Plate tears are graded from 1-3. A grade one tear is milder and they get progressively worse as more of the ligament is actually torn. The impacted toe will start to drift upwards/skywards with a higher grade tear. Grade 3 tears usually require surgery. A grade 3 tear will generally result in a raised toe or severe hammertoe and a lot of pain. You can usually heal a grade 1 or 2 tear through smart and thorough conservative treatment.
If you cant self diagnose your tear, an MRI or highly skilled diagnostic ultrasound can give you guidance on your tear and grade. Recovery times vary extremely.