Plantar plate surgery is a surgical procedure that repairs tears or ruptures in the plantar plate of the foot. The plantar plate is a strong ligament that connects the base of the toe to the long metatarsal bones in the foot and helps maintain the arch of the foot. Plantar plate tears are a common cause of forefoot pain and can make walking very difficult and painful. Surgery is often necessary to repair large or painful tears in order to relieve symptoms and improve function. But how long does this surgery take and what is involved?
Pre-Surgery
The first step before plantar plate surgery is an initial consultation with a foot and ankle surgeon. At this visit, the surgeon will perform a physical exam of the foot and order x-rays or an MRI to confirm the location and extent of the plantar plate tear. Once it is determined that surgery is needed, the pre-operative appointment will be scheduled. This is when the surgeon reviews the surgical plan with the patient, provides instructions on preparing for surgery, such as stopping certain medications ahead of time, and answers any questions about what to expect.
The pre-operative visit usually takes 30-60 minutes. Patients will also need to devote time on the day before surgery to any necessary lab work, COVID testing, or medical clearances that are required. The preparatory steps aim to optimize safety and outcomes for the surgery.
Length of Surgery
The plantar plate surgery itself typically takes 1-2 hours. This includes the time needed to administer anesthesia, position the patient, surgically expose the plantar plate, repair the tear, and close the incisions. The length can vary based on factors like:
- Size and location of the plantar plate tear
- Whether any other procedures are performed in addition, like hammertoe correction
- Surgeon’s technique and experience with plantar plate repairs
In general, isolated plantar plate repairs are shorter while those done in conjunction with additional foot osteotomies or procedures will be on the longer end of the timeframe.
Type of Anesthesia
The surgery is performed under some form of anesthesia so the patient does not feel any pain. The options include:
- General anesthesia – asleep for the surgery
- Spinal anesthesia – numb from the waist down
- Local anesthesia – foot is numbed but patient is awake
The anesthesia time needs to be factored in as well. A general anesthetic can take 30 minutes at the beginning and end of surgery to administer and wake up from. Local anesthesia only requires about 5-10 minutes to inject before the procedure starts.
Post-Surgery Time in Hospital
After plantar plate surgery is completed, patients are monitored in the recovery room for 1-2 hours. Vital signs are checked and any initial side effects of anesthesia are treated before discharge. Those who had general anesthesia may require a longer stay until the effects fully wear off. Once stable, patients can be discharged home the same day as the surgery.
Total Estimated Time for Plantar Plate Surgery
Taking into account all components of the plantar plate repair process, the total estimated time is:
| Stage | Time |
|---|---|
| Initial consultation | 30-60 minutes |
| Pre-operative appointment | 30-60 minutes |
| Day before surgery prep | 1-2 hours |
| Anesthesia | 15 min – 1 hour |
| Surgery | 1-2 hours |
| Recovery room | 1-2 hours |
| Total | 4-8 hours |
However, this does not account for travel or wait times between appointments and procedures which can add time depending on the patient’s individual situation.
Recovery Time at Home
After being discharged from the surgery center or hospital, the real healing process begins. Additional time at home is needed for:
- Resting with foot elevation to reduce swelling
- Using crutches to avoid putting weight on the foot for 4-6 weeks
- Going to physical therapy to regain range of motion and strength
- Allowing the plantar plate repair to fully heal before resuming normal activity
On average, recovery after plantar plate surgery takes 12 weeks. But this varies significantly depending on the severity of injury and how the patient responds to rehabilitation. Some are able to transition out of the boot and walk normally within 8-10 weeks. More complicated tears may require over 3 months of recovery. The foot and ankle surgeon will evaluate healing using follow-up x-rays and exams to determine when full activity can be resumed.
Partial Weightbearing
An important component of recovery is the period of partial weightbearing. This is when the foot is kept non-weightbearing or only touch-down weightbearing using crutches and a protective boot for 4-6 weeks. Exact instructions will be given by the surgeon based on findings during surgery. Strictly limiting walking and standing encourages proper healing and prevents re-injury of the repair.
Conclusion
The surgical time for plantar plate repair takes just a few hours. But factoring in pre-operative checks, anesthesia, and recovery – patients should clear their schedule for at least 4-8 hours on the day of surgery. At home recovery lasts for an additional 2-3 months depending on the individual response. While the surgical repair is relatively quick, properly protecting the area and completing physical therapy is key to achieving optimal outcomes from plantar plate surgery. Patients should be prepared to invest 12 weeks to see the full benefits after operative treatment of this common foot condition.