What is it?
The plantar plate stabilizes the toe joint and keeps the toe on the ground. A tear allows the toe to shift upward or sideways, sometimes creating a gap between toes. Left untreated, the toe can progress to a fixed deformity.
What causes it?
- A long second metatarsal that overloads the joint
- Bunions shifting weight to the second toe
- High heels or repetitive push-off
- A single injury, such as jamming the toe
What does it feel like?
- Pain and swelling under the base of the second (or third) toe
- A feeling of walking on a lump
- A toe that is drifting, lifting, or separating from its neighbor
How is it diagnosed?
A specific stress test of the toe joint during the exam, X-rays for alignment, and ultrasound or MRI to confirm and grade the tear.
When should you see a podiatrist?
- Ball-of-foot pain that is not improving
- A toe that is changing position
- Swelling at the base of a toe
Nonsurgical treatment
- Taping
- Holds the toe in a corrected position while the ligament settles.
- Stiff-soled shoes or rocker soles
- Reduce bending at the joint.
- Metatarsal pads and orthotics
- Offload the area.
- Short-term boot
- For acute injuries.
When is surgery considered?
Surgery is considered when pain or toe drift persists after appropriate conservative care, or when a complete tear is causing progressive deformity.
The ligament is repaired directly, often with a shortening osteotomy of the metatarsal and correction of any hammertoe.
Related procedures
What is recovery like?
Protected walking in a surgical shoe for several weeks, then gradual return to regular shoes. Toe swelling and stiffness can take months to settle.
Frequently asked questions
Is a plantar plate tear the same as a neuroma?
No. Both cause ball-of-foot pain, but a neuroma involves a nerve between the toes, while a plantar plate injury is a ligament problem under the joint. The exam and imaging tell them apart.