Metatarsalgia Part III: Plantar plate injuries
Welcome to the final part of our 3 part series on metatarsalgia – plantar plate injuries.
To refresh your memory, Metatarsalgia is a broad term used to describe pain around the ball of the foot – the padded area just back from your toes. There are a number of problems that cause metatarsalgia so the generalised diagnosis is often not helpful in explaining why you might be in pain. It’s also not helpful for developing a treatment plan as the different conditions that make up metatarsalgia all require very different approaches.
What is a plantar plate?
The plantar plate is a fibrous structure that runs along the bottom of the foot connecting all the toe joints to each other. It helps to stop your toes from being forced back too far as well as aiding the action of the toe tendons, guiding their pull in the right direction.
How does it get injured?
When we are walking or running, the plantar plate stretches as the foot is pushing off and the toes are bent upwards. Therefore, if you are doing anything that forces the toes upwards while adding force you are more likely to suffer a plantar plate tear or rupture.
Some people are more predisposed than others such as:
Anyone wearing high-heeled shoes
Those with a long 2nd metatarsal or a short 1st metatarsal – both of which will lead to increased pressure over the 2nd toe joint and risk of plantar plate injury
People with arthritis
What does a plantar plate injury feel like?
The symptoms can range from a mild pain to an acutely painful region depending on the extent of the damage. A small tear may feel a bit like a bruise over a local area of the ball of the foot whereas a full rupture with associated joint capsule inflammation and tearing will be incredibly painful and difficult to walk on.
The first symptoms are usually a sudden onset of pain when walking with the pain centralized around the base of a toe – often the second toe – and underneath the ball of the foot. The affected toe will slowly flex into a clawed position and worsen with time.
What can be done?
Again, depending on the severity of the injury, treatment may take the form of short-term strapping and padding to allow healing or surgery to repair a full rupture. Any underlying bony or biomechanical faults can be corrected with orthoses and footwear changes may also be needed.
Once the worst of the pain has receded, exercises to strengthen the intrinsic muscles would also be beneficial.