Plantar plate injury

Adjust activities according to pain and temporarily limit activities that increase stress on the forefoot. Pain-relieving techniques suited to the symptoms. Gentle manual therapy of the joints and periarticular tissues, avoiding any excessive direct stress on the injured plantar plate. Footwear advice and, if needed, discussion of a forefoot offloading device or a suitable foot orthosis.

Gentle mobilisation of the tarsal, midfoot and ankle joints. Progressive mobilisation of the affected metatarsophalangeal joint, only within pain-free ranges and according to joint stability. Maintenance of toe mobility without excessive tension on the plantar plate. Triceps surae stretches if ankle dorsiflexion is limited, to reduce excessive stress on the forefoot. Avoid: forced mobilisation of the affected toe into dorsal extension, repeated tensioning of the plantar plate and painful manipulation of the metatarsophalangeal joint.

Progressive strengthening, first targeted then functional, according to pain and the stability of the affected joint: intrinsic foot muscles, in particular the interossei, lumbricals and abductor hallucis depending on the affected ray; the forefoot stabilising muscles; tibialis posterior and the fibularis muscles, depending on the deficits identified; triceps surae, with a cautious progression of weight-bearing exercises to limit forefoot overload.

Single-leg balance exercises on a stable surface, then progression according to tolerance. Work on foot-strike control and foot and ankle stability. Retraining load distribution between the rearfoot and forefoot, without overloading the affected ray.

Gradual return to prolonged walking according to symptoms. Gradual reintroduction of weight-bearing activities, monitoring pain during exercise and over the following 24 hours. Progressive return to running only after clinical improvement and good tolerance of walking and functional exercises. Patient education on adjusting training loads, footwear, managing forefoot overload factors and preventing recurrence.