If capsulitis is not resolved in a timely fashion, it can progress to a more severe condition. The persistent pressure that causes capsulitis can cause a ligament called the plantar plate to erode. In turn, that can cause a plantar plate rupture, a serious injury that entered the spotlight recently when Good Morning America’s Lara Spencer went under the knife to repair this exact problem.
Basically, this kind of plantar plate injury affects one of the ligaments on the bottom of your foot. While your plantar plate is strong, made of fibrocartilagenous tissue, and meant to cover your toes and metatarsal bones, even running over the joints. Because of this ligament, your plantar plate plays a critical role in keeping your toes in their proper position.
But what causes a plantar plate rupture? And why do you often end up needing surgical treatment to repair a plantar plate rupture? Keep reading to find out.
Capsulitis and Plantar Plate Ruptures—the Surprising Connection
While plantar plate ruptures can occasionally result from traumatic injuries, they are more often the result of a condition called capsulitis.
Basically, you have supporting ligaments around every one of your joints. Now, at the joints in the ball of your foot, in between the metatarsal bones and the toes, the joints are enveloped by ligaments known as joint capsules. When that joint capsule develops inflammation, we say you have capsulitis. Of course, capsulitis can affect any joint capsule, but it most often impacts your second toe. The condition is very painful and can even cause your joint to weaken. If that happens, your toe position may shift, and you may experience worsening pain in the ball of your foot, as well as inflammation and pressure in other joints that aren’t yet affected by capsulitis. Should that occur, your plantar plate will start to wear down, degrading and eventually rupturing. Unless, that is, you seek early intervention for your capsulitis.
Early Capsulitis Detection to Prevent Plantar Plate Injuries
Have you noticed that your second toe has started reaching for your great toe, and even may sit on top of it? This can not only cause pain on top of the toe where it touches your shoe, but it can also cause pain in the joint of your foot, right behind the second toe. This condition starts as capsulitis, the inflammation of the ligaments on top of the joint. If this condition is not treated in a timely fashion, the ligaments on the bottom of the joint can weaken and tear. This is known as a rupture of the plantar plate; it’s a serious concern because it weakens the support of the toe. Then, the toe is no longer able to be held down in the correct position. As a result of this injury, the toe pops up and shifts over towards the great toe.
(Of course, your second toe can shift over for reasons other than a plantar plate rupture. It may simply be a hammer toe. But the treatment is different for each cause. So you’ll have to come into the office for an accurate diagnosis and appropriate treatment plan.)
If we suspect a plantar plate injury, we’ll typically order an MRI. This allows us to view your plantar plate and determine if it’s ruptured. If you have not yet sustained a rupture, and you’re in the early stages of this injury, your plantar plate may still be able to heal. In this case, treatment would involve taping the second toe to maintain it in the proper position, allowing it to heal. (Taping is usually most effective when the ligament tear in your plantar plate is due to a traumatic injury. But with a traumatic injury, you may also need an x-ray to rule out a broken toe.)
Treating Plantar Plate Ruptures—Timing is Everything
Now, if taping is effective in repairing the ligament, we’ll recommend wearing a custom orthotic afterward, to shift pressure away from the already weakened ligament and prevent future problems from occurring.
Unfortunately, most plantar plate injuries are not because of trauma and aren’t so easily solved. In most cases, the plantar plate ligament progressively weakens over time. When the ligament wears away and ruptures, you’re going to have to think of it as a shredded rope. In that case, no amount of taping is going to allow it to heal on its own. But you will have to look for an effective intervention. Because of the position of the second toe, it is difficult to wear a shoe and the toe becomes painful. There is also significant pain in the ball of your foot. The best treatment for a plantar plate rupture, then, is almost always a surgical repair. That was the case for Lara Spencer, and it will likely be the case for you as well.
What Can You Expect During a Plantar Plate Rupture Surgery?
The surgical procedure to repair a plantar plate rupture is involved. We being with a surgical fracture at your second metatarsal bone to expose the torn ligament. At that time, we suture the ligament and anchor it to the first bone of the second toe. This brings the toe back into alignment. Then, we repair the fracture that we created in the metatarsal bone with a metal screw. After the surgery, you’ll be in a boot for a few weeks, and you’ll have a dressing on your foot. The sutures should come out a few weeks after surgery, and you’ll usually return to full activity levels in 9-12 weeks.
Now, we know that’s a pretty big ordeal for a tiny ligament that becomes torn. But it’s a necessary one. And guess what? Even after you recover from surgery, your journey won’t be over yet. Because, as Lara Spencer learned after her surgery for a plantar plate rupture, you’ll need to go through quite a bit of rehab exercises in order to regain your former strength. However, once you’ve completed the course of post-surgical recovery, you will be free of pain in your toes and the balls of your feet. Plus, your toes will be back in proper alignment. So don’t wait another day to start treating your capsulitis or plantar plate injury. Instead, schedule an immediate appointment at our podiatry practice in Houston, TX. As soon as you come in, we can discuss your best treatment options, and get you back on your feet as soon as possible!