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Plantar Plate Rupture (Cross-Over Toe Deformity)

The Condition

The plantar plate is a thick, fibrous soft tissue structure that helps to stabilize each digit at the ball of the foot; it connects the proximal phalanx bases to their respective metatarsal bones. Injuries to this structure can vary in severity. Acute tearing of the structure can occur with rapid hyperextension of the digit, while chronic tears occur over time due to exposure of the soft tissue to repetitive activity-based stress. The injury leads to deviation, malalignment, instability and pain of the associated digit. This is sometimes referred to as a cross-over toe deformity.

The Treatment

Conservative care options are available to help temporarily stabilize the affected joint, but these methods do not provide permanent repair of the underlying torn tissues. Surgical intervention is the gold standard for treatment and is required to properly restore anatomic alignment. Surgery is typically carried out utilizing a specialized instrument system developed to repair this specific injury.

Frequently Asked Questions

Everyone. Sports involving rapid start-stop and cutting motions increase the risk for injury, as does high-heel wear. Other conditions of the foot, including hammertoes and bunions, can also predispose individuals to the development of this condition.

Physical examination of the injured joint will help your podiatrist make an accurate diagnosis. A joint manipulation referred to as the Lachman’s Test will help determine the severity of the instability. Plain film radiographs (X-rays) and magnetic resonance imaging (MRI) are also useful in determining the position of the digit and degree of soft tissue tearing.

Any of the digits can develop a plantar plate injury, but the second digit has been found to develop the problem with the greatest frequency.

Many conservative treatments are available to reduce the symptoms associated with plantar plate tears. Splinting or taping of the digit can help with maintaining temporary alignment but may prove ineffective depending upon the severity of the injury sustained. Custom made orthotics, medications and activity modification may relieve symptoms of discomfort.

Surgical repair of both acute and chronic tears of the plantar plate result in restoration of the torn tissue with reduction of the associated digital deviation. The surgical instruments for this procedure were specifically developed for this injury. This allows for consistent and reproducible results in comparison to some other less modern repair techniques. The incision is carried out through a small skin incision and requires a 6 week recovery following the repair. Patients can bear weight on the surgical foot almost immediately following the procedure.

Videos

Complete Plantar Plate RepairThis surgical technique illustrates the approach used at JCMG Podiatry to reconstruct the anatomic structure that leads to the instability of the second digit MTP joint.