Pain in the forefoot can be attributed to a range of different injuries, including plantar plate injuries.
What are plantar plate injuries?
The plantar plate has a big role to play in keeping the forefoot functioning properly.
It is a rectangular ligament that runs across the bottom of the forefoot – from the big toe to the little toe.
To properly understand the function of the plantar plate, we need to understand the basic anatomy of the ball of the foot.
The joints of the forefoot are known as the metatarsophalangeal joints (MTPJs). These are the joints that you are standing on when you stand on your tippy toes. This part of the foot also helps to propel us forward and take our next step when walking. Within the forefoot, there are many muscles, ligaments, tendons and joint structures that help it function properly.
The plantar plate has many functions, including:
- Keeping the toes together and in alignment, which creates stability through the forefoot
- Help to reduce the load on the ball of the foot
- Keep the tendons which attach onto the ball of the foot in alignment
- Resist hyperextension of the big toe (in an upwards direction)
When there is a weakness in the plantar plate, this can lead to forefoot pain. This can also impact your day to day activities. Injuries to the plantar plate can range from a mild injury to a degeneration to a tear. Plantar plate injuries are most common underneath the 2nd toe.
What does a plantar plate injury feel like?
Patients often describe their plantar plate injury as feeling like a mix of sharp pains and cramping through the forefoot.
It is most painful during the propulsive phase of the gait (seen in the image to the right), as this is when the forefoot is under the most pressure.
Changing direction during sport and exercise can also cause pain as force is placed through the forefoot.
Most of the pain experienced, is localised to the injury, but some referred pain can occur to the rest of the forefoot.
What causes plantar plate injuries?
Depending on the cause of the injury, plantar plate injuries can be classified as either acute or chronic.
Some of the potential causes of plantar plate injuries include:
- Traumatic Injury such as jumping or landing on the forefoot.
- Long term high heel wearing places excessive pressure through the forefoot and disrupts the integrity of the plantar plate.
- Bunions (hallux abductovalgus) result in a deviation of the big toe towards the midline of the body. As a result, the 2nd toe often needs to move out of the way to accommodate this. This can lead to chronic damage and degeneration to the plantar plate.
- Stubbing injuries where the toe is moved out of its alignment.
- Biomechanical abnormalities can often occur when the big toe is not functioning properly, such as with bunions, and the load needs to be spread to the other toes. Your big toe is the main driving force in the propulsion phase of gait, however if this is impacted at all, the 2nd toes steps up and takes the load. This can lead to damage of the plantar plate.
- A longer 2nd toe, as this increases the force placed on this toe and can therefore impact on the plantar plate.
Long term high heel wearing places excessive pressure through the forefoot and disrupts the integrity of the plantar plate.Who does it affect?
Plantar plate injuries are most common in those who participate in physical activity.
Women and those who wear high heeled shoes are also most likely to sustain a plantar plate injury.
Plantar plate injuries can occur in the general population as a stubbing injury or through improper footwear.
How are plantar plate injuries diagnosed?
Plantar plate injuries often result in a ‘splaying’ or ‘retraction’ of the toes, as the ligament is no longer able to keep the toes properly aligned. This is a clear sign that the plantar plate is damaged!
Pain is often present when we palpate the plantar plate itself, and along the bottom of the forefoot.
We will often refer for an x-ray and/or ultrasound to assess any other injuries in the area. This will also help to determine the degree of the injury, particularly if a tear is suspected.
What treatments are available for plantar plate injuries?
Treatment options for plantar plate injuries depend on the severity of the injury.
Some of the treatments used include:
- Icing
This helps initially to help reduce pain and swelling in the area, particularly if you spend long periods of time on your feet
- Toe props and silicone devices
These can help to offload the affected toes and provide cushioning. If there is a hammer toe present due to a plantar plate injury, these devices can assist with protecting the top of the toes from friction and pressure in footwear.
- Padding and taping
Padding can also help to provide cushioning and support of the forefoot. Taping can help with the alignment of the toes and help to reduce the pressure on the injury or tear.
- Surgery
This may be required in severe cases, such as with a significant tear, or when the tear is beginning to significantly impact the function of the feet as a whole.
If you’re experiencing pain like we’ve described today, or any pain or discomfort in your feet and/or lower limbs, come see us at Watsonia Podiatry. Our expert team is here to help you and your feet today. You can book an appointment to see us by calling us on (03) 9432 2689 or book online here.
