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Plantar Plate Repair

Plantar plate repair is a surgical procedure performed to restore stability to the lesser toe joint when the plantar plate ligament is torn or weakened. The plantar plate is a thick band of fibrous tissue located under the lesser toe joints (most commonly the second toe) that prevents excessive movement and toe dislocation.

 

Indications for Surgery

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  • Toe drifting or instability, often causing crossover toe deformity.

  • Persistent pain under the ball of the foot (forefoot pain or metatarsalgia).

  • Failed non-surgical treatments such as taping, orthotics, or footwear changes.

  • Pain with walking, standing, or wearing shoes due to joint instability.

 

Plantar plate repair restores normal toe alignment, relieves pain, and prevents worsening deformity.

What Does the Surgery Involve?

Plantar plate repair is performed under regional or general anesthesia. 

 

The steps include:

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  1. Incision Over the Toe Joint – A small cut is made on the top or bottom of the foot, depending on the technique.

  2. Exposing the Plantar Plate – The joint is opened to assess the ligament damage.

  3. Plantar Plate Repair – The torn ligament is sutured and reattached to the bone.

  4. Toe Realignment – If needed, additional procedures such as Weil osteotomy (metatarsal shortening) or toe fusion may be performed.

  5. Closure and Bandaging – The incision is stitched, and a dressing is applied.

 

A temporary wire or internal sutures may be used to hold the toe in place during healing.

Alternative Treatments

Before considering surgery, non-surgical treatments may help manage symptoms:

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  • Toe Taping or Splinting – Helps temporarily realign the toe.

  • Custom Orthotics (Insoles) – Can offload pressure from the affected joint.

  • Footwear Modifications – Wide, cushioned shoes can reduce pain.

  • NSAIDs or Steroid Injections – Temporary relief but do not repair the ligament.

 

Surgery is recommended when non-surgical treatments fail, and pain or deformity significantly affects daily life.

Risks and Complications

Plantar plate repair has a high success rate, but some risks exist:

 

General Surgical Risks:

  • Infection (<1–3% risk) – Treated with antibiotics if needed.

  • Blood Clots (DVT/PE) – Uncommon but possible with reduced mobility.

  • Nerve Injury – Temporary or permanent numbness near the incision site.

 

Procedure-Specific Risks:

  • Stiffness or Scar Sensitivity – The joint may remain stiff, or the scar may be tender.

  • Floating Toe – The toe may not touch the ground properly post-surgery.

  • Nonunion or Malunion – If a bone-cutting procedure (osteotomy) is performed, it may not heal correctly.

  • Recurrence of Deformity – If underlying causes (e.g., foot mechanics) are not fully corrected, the problem may return.

  • Fracture – Rare but possible if excessive bone removal is required.

  • Metal Prominence (if hardware is used) – Screws or pins may cause irritation and require later removal.

 

Most patients experience significant pain relief and toe stability after surgery.

Recovery and Rehabilitation

Time Off Work

  • Desk jobs: 2–4 weeks

  • Manual labor: 6–8 weeks

 

Return to Driving

  • 4–6 weeks, depending on swelling and pain.

 

Return to Activities & Sports

  • Walking unaided: 4–6 weeks

  • Running or high-impact activities: 10–12 weeks

 

Rehabilitation Timeline

  • Weeks 0–2:

    • Protected weight-bearing in a post-op shoe.

    • Foot elevation to reduce swelling.

  • Weeks 2–6:

    • Gradual return to normal footwear.

    • Gentle toe exercises to prevent stiffness.

  • 6+ weeks:

    • Resume daily activities.

    • Minor swelling may persist for several months.

 

With proper healing, most patients regain normal toe function and pain relief.

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