This line of conservative therapy should be attempted for at least a good two to six months to give the plantar plate a chance to heal. If it does not – then you should move onto injection therapy to attempt to resolve the inflammation in the joint.
The danger with a cortisone shot is that while it will remove the pain initially and start decreasing the inflammation which is essential to healing, it will on the other hand weaken the already damaged ligaments and tendons in the area.
-The injection of cortisone and dexamethasone phosphate should be injected from the plantar aspect (this is where the plantar plate tear is located). Injecting into the MTPJ will likely not be effective as this is not the primary site of inflammation. It is essential that the patient keep the toe well protected with tape, padding, orthotics, shoe wear, icing and stretching. The tendon will be susceptible to further damage at this point. There is a real chance of rupture of the plantar plate occurring so this should not be taken lightly.
-Injection therapy is the last choice before surgery must be considered.
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