Plantar Plate Injury – a common cause of forefoot pain

Plantar plate injury (also known as plantar plate tear or plantar plate dysfunction) is one of the most common causes of pain in the ball of the foot or under the toes, though it’s a condition a lot of people haven’t heard of.

What is a plantar plate?

A plantar plate is a thick fibrocartilaginous or ligamentous structure. In the foot, plantar plates connect each of the metatarsals to the corresponding proximal phalange of each toe.

Plantar plates assist in stabilising the metatarsophalangeal (MTP) joints, allowing the foot to withstand the compressive and tensile loads associated with weight-bearing, and to resist excessive dorsiflexion and hyperextension of the MTP joints.

Plantar plate dysfunction can lead to subluxation or dislocation of the involved joint. Due to the role of the plantar plate in stabilising the MTP joints, people with plantar plate dysfunction will often also have a painful hammertoe.

What does plantar plate dysfunction feel like?

People with plantar plate dysfunction will typically feel pain in the ball of the foot, under the affected joint. There can also be swelling. The joint may be dorsiflexed (sitting up) when standing. A plantar plate tear may result in splaying and/or clawing of the toes (as in hammertoe).

Other conditions that cause ball of foot pain and present with similar symptoms to plantar plate dysfunction include neuromas, capsulitis or bursitis.

What causes plantar plate dysfunction or tear?

Plantar plate dysfunction more commonly affects the second metatarsal joint (base of the 2nd toe) although it can occur in other or multiple joints.

Plantar plate dysfunction is frequently associated with a hallux valgus deformity (commonly known as a bunion), whereby the big toe angles in toward the second toe. A hallux valgus deformity can cause abnormal forefoot loading patterns, contributing to a repetitive-type injury to the plantar plate of the 2nd toe.

Other factors contributing to abnormal loading of the plantar plate at this point include excessive pronation, and sometimes the longer length of the second metatarsal.

Certain types of footwear, including tight, unsupportive, and high-heeled shoes, can increase pressures under the foot. It can also be caused from a direct injury or trauma to the foot.

What is the treatment for plantar plate dysfunction or tear?

Strapping the affected toe and padding are often used to treat the affected toe and can give immediate pain relief in some patients. In the early stages strapping can be helpful in preventing progression of the condition and subsequent dislocation.

It is  important to avoid unsupportive shoes and high heeled shoes as they are often the cause. Sometimes anti-inflammatory medication may be required.

Our Melbourne podiatrists can also provide some padding or orthotics to minimise forces and support the optimal foot position.

At times, in severe cases plantar plate injuries require surgical repair, and other corrections such as hammertoe or tendon repairs may be required. Our Melbourne podiatrists can provide advice on the most appropriate procedure for your circumstances and can refer you to a specialist if required.

How can I prevent plantar plate injuries?

Prevention of plantar plate injury is focused on optimising foot function and minimising abnormal stresses to the plantar plates of the foot. At Melbourne Podiatrists and Orthotics our podiatrists  can conduct a thorough biomechanical assessment and provide advice with regard to footwear and orthotics to reduce your risk of plantar plate dysfunction.

Do you suffer ball of foot pain?

At our Melbourne foot clinic our podiatrists are experts in forefoot injuries including plantar plate injuries.

So if you suffer from ball of foot pain, book an appointment with one of our friendly podiatrists today!