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The Perc-MTP-VL Procedure

The Trusted Non-surgical Plantar Plate Tear Treatment

What if you could skip the plantar plate surgery and get a procedure that would promote repair of the tear with less downtime? The Perc-MTP-VL Procedure is that solution.

The Perc-MTP-VL is an image-guided injection of your own orthobiologics  to enhance natural healing. in the plantar plate. It uses a combination of ultrasound and x-ray guidance to inject either high dose platelets or bone marrow concentrate directly into the tear to promote healing. We’ve been using this procedure for many years with excellent results and a fraction of the down-time associated bigger surgical or radio-frequency approaches.

What is a Plantar Plate Injury?

The plantar plate is a fibrocartilage structure located at the ball of the foot.  The ball of the foot involves a joint which anatomically is called the metatarsal phalangeal joint (MTP) joint.  The MTP joint is where the long foot bone (metatarsal) meets the toe (phalanx).

Each toe in the foot has an MTP joint which is numbered 1 through 5.  The plantar plate allows the foot to absorb the enormous forces of walking and running in addition to limiting extension (1).  There are ligaments that attach the plantar plate to the long bones of the foot which are illustrated by the red and blue bands in the picture.  The plantar plate and the supporting ligament provide critical stability for the MTP joint (1)

What are the Symptoms of Plantar Plate Tear?

The most common thing patients notice after a plantar plate injury is either pain in the toe joint itself or at the bottom of the joint, where the toe meets the floor. Many times this pain is confused with sesamoiditis,  which is when the small bone at the bottom of the toe gets inflamed. The pain is often made worse with activity and may feel better in stiff-soled shoes as this protects the area more. Pain is more severe at “toe-off” or when you push off with your toes while walking or running.

How is a Plantar Plate Tear Diagnosed?

MRI is the gold standard for plantar plate injury diagnosis (5). A plantar plate injury can also be diagnosed using ultrasound imaging (2). However, this type of injury usually can’t be diagnosed with x-rays. The tears in the plate are graded 0-4 based on severity. The least severe is a grade 0 where the fibers of the plate are stretched. In a grade 1 tear, less than 50% of the plate is torn whereas in a grade 2 more than 50%. Grade 3 is more extensive and involves the collateral ligaments. Grade 4 is is a complete disruption and dislocated.


  1. Nery C, Baumfeld D, Umans H, Yamada AF. MR Imaging of the Plantar Plate: Normal Anatomy, Turf Toe, and Other Injuries. Magn Reson Imaging Clin N Am. 2017 Feb;25(1):127-144. doi: 10.1016/j.mric.2016.08.007.
  2. Stone M, Eyler W, Rhodenizer J, van Holsbeeck M. Accuracy of Sonography in Plantar Plate Tears in Cadavers. J Ultrasound Med. 2017 Jul;36(7):1355-1361. doi: 10.7863/ultra.16.06067.
  3. Jordan M, Thomas M, Fischer W. Nonoperative Treatment of a Lesser Toe Plantar Plate Tear with Serial MRI Follow-up: A Case Report. J Foot Ankle Surg. 2017 Jul – Aug;56(4):857-861. doi: 10.1053/j.jfas.2017.02.016.
  4. Prissel MA, Hyer CF, Donovan JK, Quisno AL. Plantar Plate Repair Using a Direct Plantar Approach: An Outcomes Analysis. J Foot Ankle Surg. 2017 May – Jun;56(3):434-439. doi: 10.1053/j.jfas.2016.12.002.
  5. Duan X, Li L, Wei DQ, et al. Role of magnetic resonance imaging versus ultrasound for detection of plantar plate tear. J Orthop Surg Res. 2017;12(1):14. Published 2017 Jan 21. doi: 10.1186/s13018-016-0507-6
  6. Ojofeitimi S, Bronner S, Becica L. Conservative Management of Second Metatarsophalangeal Joint Instability in a Professional Dancer: A Case Report. J Orthop Sports Phys Ther. 2016 Feb;46(2):114-23. doi: 10.2519/jospt.2016.5824.
  7. Nery C, Coughlin MJ, Baumfeld D, Raduan FC, Mann TS, Catena F. Prospective evaluation of protocol for surgical treatment of lesser MTP joint plantar plate tears. Foot Ankle Int. 2014 Sep;35(9):876-85. doi: 10.1177/1071100714539659.