Plantar Plate Tear – ‘Toe Gapping’ sign

Image 1: Showing the ‘V’ gap that appears between the 2nd & 3rd toes and the location of the plantar plate

What is the plantar plate?

The plantar plate is a cartilage sling that is the only thing that provides side-to-side stability to the middle toes of the foot. If it tears, the toes can deviate creating a V gap between the toes, almost always between 2nd and 3rd toes or the 3rd and 4th toes.

Who Gets it and Why ?

Image 2: Showing normal & faulty toe alignment

A plantar plate tear is commonly associated with a pronated or rolled in foot. This mechanical problem results in the biggest metatarsal bone failing to do its job properly and putting its share of weight onto the smaller bones of the lesser toes. Image 2 shows this pattern change. The excessive pressure causes a deterioration in the strength of the cartilage over several decades. Ultimately, it is usually a ‘small straw that broke the camels back’ event, perhaps even an ordinary step, which results in the tear.

Pain is experienced for around two weeks as the tear heals its raw edges. While the pain will go fairly soon, the plantar plate tear will open up under pressure from the small lumbrical muscles in the foot and it will not come together. It will heal in its new position, allowing the toe that it relates to, to drift sideways. In summary, plantar plate ruptures occur in pronators, most commonly women over 40 years of age

What can be done ?

Prior to the plantar plate tear occurring, the area will probably feel bruised and be quite likely to develop a layer of callusing as a result of the increase in pressure. If addressed at this time, it is likely that the tear can be avoided by making the foot pressures
normal again by the use of orthotics.

If the tear has just occurred, a simple pad that covers the ball of the foot with a cut out to the sore area will help a lot to reduce pain. In the long term, while orthotic devices will protect the area and reduce ongoing symptoms of overloading in the forefoot, surgery is the only method of correcting the gapping toes. While the physical repair of the tear is simple surgery, the placement of the incision and the resulting scar can cause ongoing problems. Proper advice and consideration is necessary before proceeding to this step