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Plantar Plate Injury

Discussion in 'Biomechanics, Sports and Foot orthoses' started by footsoldier, Jun 2, 2013.

  1. footsoldier

    footsoldier Member

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    Hi all,

    I'm looking for some advice. Patient has recently been referred for orthotic intervention for plantar plate ligament injury. Previously was prescribed a carbon fiber plate. Proved to uncomfortable. Has been using taping techniques with his orthoses. Are there any forefoot adaptions that other Pods have used with good results? I have researched the "Cluffy Pad". Was considering this. Any other suggestions?
    Many thanks in advance,
  2. Here is a modification I use very commonly for plantar plate injuries to the 2nd metatarsophalangeal joint which I have described numerous times here already on Podiatry Arena.
  3. Admin2

    Admin2 Administrator Staff Member

  4. spodd

    spodd Member

    Not my thread, but thanks for the picture Kevin, wondering what Korex is? Is it s stiff material? do you cover the orthotic shell with korex then spenco or just smooth it off and attach it at the distal end of the shell
  5. Bruce Williams

    Bruce Williams Well-Known Member

    Better still you might consider eliminating the first ray post in Kevin's diagram and I stead utilize a 3-5 mm digital skied pad sub hallux, ie a cluffy wedge. This will load the first much better in the majority of instances.

  6. Korex, a rubberized cork material, is very similar in characteristics to ethylene vinyl acetate (EVA). In other words, korex is grindable and flexible like EVA and resists compression forces well. Korex is used as a forefoot extension, starting generally just distal to the orthosis shell and ending at the digital sulcus. In this instance, the korex forefoot extension is designed to increase the ground reaction force plantar to the 1st, 3rd, 4th and 5th metatarsal heads which, in turn, decreases the ground reaction force plantar to the 2nd metatarsal head. I prefer this modification vs the Cluffy wedge since it fits inside the shoe better and doesn't cause dorsal hallux irritation like the Cluffy wedge often does.
  7. Bruce Williams

    Bruce Williams Well-Known Member

    Dorsal irritation from a digital wedge can be an issue and can be controlled. I find that restricting the dorsiflexion of the 1st mpj via a Korex Morton's extension can be much more problematic to overall foot function.
  8. Sean:

    Also make certain that your patient is icing the plantar foot 20 minutes, twice daily, in the area of the plantar plate injury. Icing therapy is very effective for plantar plate injuries since it reduces plantar edema which, in turn, will reduce plantar pressures on the plantar plate and greatly increase the comfort for the patient during weightbearing activities.

    Please let us know how your treatments work with your patient for the benefit of all those following along.

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