7 Exercises for Plantar Plate Tear: How to Heal
Updated March 2024
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The foot is a complex structure comprising bones, tendons, ligaments, and muscles. All of these work together towards allowing movement, absorbing shock, bearing weight, and maintaining balance.
The foot is divided into three parts- forefoot, midfoot, and hindfoot. An injury to any one of these could result in painful conditions that can restrict movement. Plantar plate tear is one such forefoot injury commonly seen in runners and in people who play sports like soccer, basketball, and baseball. This tear causes sharp pain or ache in the ball of the foot. In extreme cases, it could cause dislocation of the toe.
This article discusses the causes and symptoms of plantar plate tears. It also offers an insight into the treatment of this condition and offers seven simple exercises that help in recovery. These exercises, if performed mindfully, can help loosen muscles, increase mobility, and provide strength and stability to the toes.
What is a Plantar Plate Tear?
Plantar plates are disc-shaped, tough, fibrocartilaginous tissue on the bottom of the feet that are held in place by a thick ligament. This plantar plate ligament connects the ball of the foot to each toe. It shields the feet from pressure and absorbs shocks during strenuous and day-to-day activities.
The plantar plate is also responsible for providing stability and alignment to the toes and preventing them from over-extending. Repetitive overload and overuse put the plantar plate ligament under constant strain. The strain causes a gradual breakdown of the ligament until it eventually rips apart. This damaged ligament causes a painful forefoot ailment known as a plantar plate tear.
What are the Symptoms of Plantar Plate Tears?
Forefoot disorders often exhibit similar-looking symptoms, leading to the wrong diagnosis and treatment. For example, forefoot pain is a common symptom across patients with plantar plate tears, neuromas, and bunions. However, some tell-tale signs and symptoms directly point in the direction of a plantar plate tear, with the most prominent being significant pain and swelling under the second and the fourth toe. The pain often extends toward the toes.
Generally, a plantar plate tear can affect any toe. However, by sheer reason of the anatomy of the second metatarsal, the second toe seems to be the most commonly impacted one. A burning sensation, tingling, or numbness between the toes accompanies the pain.
Another classic symptom described by patients is that of ‘walking on the bones of the feet.’ Swelling and redness of the skin on the top of the foot are common complaints, and so is the inability to wiggle or raise the toes upwards without experiencing pain.
Lastly, in slightly advanced cases of such tears, the toe begins to drift away from its original position, causing a V-shaped gap between them. Tears arising due to sudden trauma are likely to cause more acute pain, while those that develop over time have a slow onset and cause significant pain as they deteriorate progressively.
What Causes a Plantar Plate Injury?
A plantar plate ligament tear is responsible for causing plantar plate injuries. This tear is also referred to as a plantar plate sprain since sprains are nothing but tearing or twisting of ligaments.
Sudden trauma, an athletic lifestyle, ill-fitting shoes, prolonged use of high heels, walking barefoot on hard surfaces, wear and tear over time- nearly anything might contribute to these injuries. There are a few other injury–causing factors, which can be categorized into two groups: anatomy-induced injuries and injuries from pre-existing foot disorders.
Anatomical causes of a plantar plate injury include feet with naturally high arches or feet with flattened arches as a result of overpronation. Toes with a short first or long second metatarsal bone and hypermobility are other anatomy-induced causes. Foot disorders such as hammertoe and bunions exert extra pressure on the plantar plate. The strain causes the ligament to thin out, stretch, and eventually dislocate.
Can a Complete Plantar Plate Tear Heal Itself?
While a partial plantar plate tear can easily heal itself with proper rest and care, a complete tear poses challenges when it comes to healing. A complete tear simply means loss of stability and, in some cases, a change in the appearance of the foot.
It is possible to treat plantar plate tears through conservative treatment methods before deciding on the need for surgery. The first step is to deploy the RICE (Rest, Ice, Compression, and Elevation) method. This method aids in pain alleviation, inflammatory reduction, and blood flow to the plantar plate area. Physical therapy, using splints (affiliate link), metatarsal pads (affiliate link), and shoes with appropriate foot support helps recovery. A combination of massage and exercise works towards speeding up the healing process.
While recovery from this tear is possible, it is essential to bear in mind that recovery can take up to a few months. If the injury does not respond to these modes of treatment, and there is no pain reduction, it would be wise to let a qualified doctor investigate further and choose the appropriate course of treatment.
7 Exercises for Plantar Plate Tears
1. Toe Scrunches
A torn plantar plate can weaken the muscles in the foot. Toe scrunches work on improving the strength and endurance of such muscles on the bottom of the feet. This exercise is also effective in providing pain relief from foot pain caused by a plantar fascia.
Steps:
• Take a seated position and place a towel or pillowcase on the floor
• Place your feet on the towel and start pulling it towards you by curling your toes
• Unflex and repeat a few more times until you pull the entire towel toward you
• Frequency: 3 sets of 10 repetitions, twice daily
2. Lesser Toe Flexion Exercise
The lesser toe flexion exercise is beneficial in strengthening the flexors and the small muscles in the foot.
Steps:
Stand on the edge of a step and place a resistance band around your lesser toes
Keeping your hand firmly at 90 degrees and force of the band, constant
Flex your lesser toes against the band; hold for 10 seconds and lift the toes back to the starting position
Frequency: 3 sets of 15 repetitions each, once daily
3. Soleus Stretch
The Soleus stretch is an effective exercise to loosen the soleus muscle, which is
located behind the shin. It helps maintain mobility and reduces the extra load on the
plantar plate.
Steps:
Stand upright with the affected leg behind you and your knee straight
The knee of the front leg should have a slight bend
Move forward on the front leg, keeping both heels on the floor
Stop the forward movement once you feel a stretch on the back leg and hold for 40 seconds.
Frequency: 2 sets of 15 repetitions, 3 to 4 times a day
4. Toe Push-Ups
Toe push-ups work on strengthening the intrinsic foot muscles.
Steps:
Stand upright with your feet flat on the floor
Slowly glide up your greater toes, increasing your foot arch in the process
Release toes to the starting position
Frequency: 3 sets of 15 repetitions, 4 times a day
5. Calf Raises
Calf raises increase mobility and also protect against leg injuries. In case of a plantar plate tear, calf raises should only be considered if the pain has subsided in the ball of the foot.
Steps:
Stand with the balls of your feet on the edge of a step
Lift or push your heels up as much as possible
Slowly return the heels until they are slightly below the step
Return to the starting position once you feel a stretch in the calf muscles
Frequency: 1 set of 5 to 10 repetitions once a day
6. FHL Strengthening
A strong big toe is vital to weight bearing, walking, and running. The FHL (Flexor Hallucis Longus) strengthening exercises flex the FHL muscle and help maintain its strength while recovering from a plantar plate tear.
Steps:
Start in a seated position with your legs stretched out in front of you
Wrap a resistance band around the big toe
Lower the big toe towards the floor, against the resistance band, and slowly release the toe
Frequency: 3 sets of 15 repetitions, once daily
7. Balance Exercises Using a Wobble Board
A plantar tear can affect the stability of the foot. Wobble board exercises are a great way of slowly restoring balance to the feet. In addition to providing stability, these exercises also increase abdominal strength.
Steps:
Stand on the wobble board with your feet hip distance apart
Stand upright and maintain a neutral spine
Focus on a point straight ahead for stability
Shift your weight so the edges of the board do not touch the floor, and hold for 30 seconds.
Frequency: 3 sets of 10 repetitions, once a day
When Should You Consider Plantar Plate Surgery?
Plantar plate tears often respond and recover with conservative treatment methods. But in rare cases, the injury does not respond to treatment and continues to be painful. This could mean that the plantar plate is completely ruptured and may be beginning to interfere with other structures around the area. In such cases, doctors may consider surgical intervention.
Final Thoughts
While a plantar plate tear is a painful condition that can potentially impede normal life, it can be cured effectively with proper care and rest. The key is to diagnose the condition early so that it can be treated at the nascent stage without having to go into surgery.
Frequently Asked Questions
Is a massage good for plantar plate tear?
A soft tissue massage can go a long way in healing a plantar plate tear. It not only helps to increase mobility but also loosens tight muscles and tendons. A good massage can remove chronic inflammatory fluid that can slow down the ligament repair process.
Can you walk with plantar plate tear?
It is a good idea to reduce walking for at least the first six to eight weeks of having a plantar plate tear. Resuming the activity should be a gradual process. It is recommended that you do not walk barefoot and wear cushioned trainers as much as possible.
How long does a partial plantar plate tear take to heal?
Recovery from a partial plantar plate tear can be a lengthy process. Depending on the severity of the tear, it may take three to six months to heal. Most partial tears will fully heal within this time, but larger tears may require a doctor's attention for further evaluation.
What happens if a plantar plate tear goes untreated?
A plantar plate tear should not be left untreated, as it can become chronic and lead to degenerative joint diseases like arthritis. If the extent of damage to the plate is large, it can cause a toe dislocation, which will then need surgical correction.
This article has been reviewed by our editorial board and has been approved for publication in accordance with our editorial policy.
