Turf Toe Not Getting Better? Here’s A Quick Test for a Plantar Plate Rupture

Plantardorsal Translation Test from NYSportsMed & Physical Therapy on Vimeo.

When you have a turf toe that is not progressing to conservative treatment, appreciate the possibility that the patient may have a rupture of the plantar plate. Sometimes coming to that conclusion can take weeks of slow rehabilitation with minimal results.  To save time and energy in recognizing a plantar plate tear early on, there is a special test for the foot analogous to the lachman test in the knee called the plantardorsal translation test, or the vertical stress test.  This test is used to check for a tear of the plantar plate.  The distal metatarsal bone is stabilized with one hand; the other hand grasps the proximal phalanx and performs a vertical shear force.  The test is negative for a plantar plate rupture if there is a good endpoint and is positive should there be an absence of a good endpoint.  If you do get a positive test, both xrays and MRI’s are useful in assessing to what extent the plantar plate is injured.  A discussion with the patients physician would be recommended at this point regarding the next step for the patient’s care.

Dilnot M , Michaud TC . Plantar Plate Rupture . Australasian Journal of Podiatric Medicine. 2003 ; 37 ,( 2 ): 43 – 46 .

Video clip provided by Bob Anderson, MD and James Nunley, II, MD.