Several NFL players have sustained plantar plate injuries recently which will end their 2012 seasons: Pierre Garcon, Sean Lee, and Carl Nicks. What is this injury and why is it so serious? The plantar plate is a flexible but strong structure under the metatarsal phalangeal joints. These joints connect the proximal phalanx with the metatarsal bone. An example of a metatarsal phalangeal joint is your big toe joint. It is a structure that prevents upward movement or dorsiflexion of the toes and connects from the base of the toe to the plantar fascia (a thick band that runs along the bottom of the foot). It is connected to the collateral ligaments on the sides, and the thick fibrous and cartilaginous structure keeps toes straight.
Mild tears to the plantar plate can be treated with conservative therapies: ice, rest, immobilization, strapping downward, anti-inflammatory medications, and orthotics. However, more severe cases or those that fail conservative treatment need surgical intervention. Elite athletes that play sports such as football can encounter such extreme forces that the plantar plate will endure a severe tear and must be surgically repaired. Conventional x-rays may be helpful, but the plantar plate is a soft tissue structure that needs MRI or Ultrasound to be adequately visualized. These imaging modalities are essential for proper diagnosis and surgical planning.
Dr. Bender is a podiatrist at Advanced Physical Medicine and practice at the Oak Park and 63rd Street (Chicago) locations. She is an instructor at William Scholl College of Podiatric Medicine. Appointment can be made by calling: 708-763-0580 (OP) and 773-776-3166 (63rd).