Plantar Plate Tear

A tear or rupture of the rectangular ligament that is formed by the plantar fascia and the plantar capsule under the ball of the foot.

This ligament’s primary role is stabilizing the digit through resisting hyperextension of the digit. It is also important in reducing compressive loads of the metatarsal heads. It has a secondary function in guiding the line of pull for the some of the little muscles inside the foot.  

Causes / Risk factors 

  • Overload – Abnormal forefoot loading patterns 
  • Biomechanical abnormalities:
    • Bunions
    • Long 2nd metatarsal 
    • Short 1st metatarsal 
  • High heeled footwear 
  • Inflammatory arthropathies (Rheumatoid arthritis, Psoriatic arthritis, Ankylosing Spodylitis) 
  • Athletes – esp. ballet and athletics 
  • History of trauma 

Clinical symptoms 

Typically occurs at the 2nd metatarsophalangeal joint (MTPJ) but can occur on other MTPJ’s. It is characterized by localized pain underneath the MTPJ on forefoot. Often described as a “bruise” or “stone in the shoe”. It’s usually painful at the base of the proximal phalanx and is aggravated by dorsiflexion. Swelling is possible above and below the joint.  

The condition progresses from an early stage increasing subluxation of the digit (partial dislocation). At this point the condition is reversible but if left unattended is likely to progress to chronic dislocation of the digit and what is termed “crossover toe” (see below image).


Usually, diagnosis can be confirmed with ultrasound after some testing is performed by your podiatrist.

This is usually in conjunction with pain in the right area consistent with a plantar plate tear.


Plantarflexion of the digit until 2-3months for complete recovery. 

  • Rest and ice 
  • Digital/forefoot padding (bar/forefoot padding proximal met heads) 
  • Cushioning  
  • Strapping (Ribbon taping of digit plantarly 
  • Orthoses with or without padding 
  • Rocker bottom footwear 
  • Stiff soled footwear 
  • Cortisone  
  • Surgery (hammer toe correction / deformity)