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In my last video, I discussed the condition known as capsulitis. If capsulitis is not resolved in a timely fashion it can progress to a more severe condition. My name is Dr. Andrew Schneider and I'm a podiatrist in Houston, Texas. The persistent pressure that causes capsulitis can cause a ligament called the plantar plate to erode.  

Have you noticed that your second toe has started reaching for your great toe and even may sit on top of it. This cannot only cause pain on top of the toe where it contacts your shoe, but also causes pain in the joint at the ball of your foot, right behind your second toe. This condition starts as capsulitis, the inflammation of the ligaments surrounding the joint. If not treated in a timely fashion, the ligament on the bottom of the joint can weaken and tear. This is known as a rupture of the plantar plate. 

A rupture of the plantar plate weakens the support of the toe. The toe is no longer able to be held down in a correct position. As a result of this injury, the toe pops up and shifts over towards the great toe. 

It's possible that the toe can shift towards your great toe for other reasons, than a plantar plate rupture. It may simply be a hammer toe. The treatment of each are different, so I have to make sure that the right condition is properly treated. 

In order to assess the status of the plantar plate, I will order an MRI. An MRI will allow me to examine the ligament to see if it's ruptured or not. This is important to know since the treatment for a hammer toe differs from the treatment of the planter plate. 

If it's in the early stages of an injury, it's possible for the ligament to heal. In that case I would tape your toe to maintain it in a proper position for the ligament to heal. This may be effective if the torn ligament is due to a traumatic injury. For instance, let's say you trip over a curb. The next day, you see that your second toe is up and over your great toe. That's the perfect time to come into the office for treatment. I'll take an x-ray to make sure nothing is broken and I'll show you how to tape your foot. To get that toe back down. For an acute injury like that, taping is an effective way to reposition the toe and allow the plantar plate to heal. If taping is successful and repairing the ligament, I recommend the use of a custom orthotic afterwards. This will shift pressure away from an already weakened ligament to 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 in ruptures, think of it as shredded rope. No amount of taping is going to allow it to heal on its own. 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 at the ball of your foot. 

The best treatment for a plantar plate rupture is to repair it surgically. The surgical procedure to repair the plantar plate is involved. A surgical fracture is made in the second metatarsal in order to expose the torn ligament. At that time, ligament is sutured and anchored to the first bone of the second toe. This is what brings the toe back into alignment. The fracture that I created in the metatarsal bone is then repaired with a screw. 

After the surgery, you'll be in a boot for a few weeks, as well as having a dressing on your foot. Sutures come out in 2 to 3 weeks and you're usually back in to full activity in 8-12 weeks. That's a pretty big ordeal for a tiny ligament that becomes torn, But it's a necessary one.