When the plantar plate of the foot is overloaded or strained, it can tear. While injury to this part of the foot occurs most often during active sports, it can also occur as the result of a fall or through overuse.
What is the plantar plate and why does it tear?
The plantar plate is a thick ligament that runs along the ball of your foot. Its job is to stabilize the joints. It protects the long bones of the foot from too much pressure and prevents our toes from spreading too far apart and overextending.
While this tear could happen to any of the ball of foot joints, it happens most often to the joint in the 2nd toe, the one right next to the big toe. That’s because the 2nd toe joint is the longest of all the toe joints, it bears the most force, making it more vulnerable to tears.
What are the risk factors?
The following factors can contribute to your risk of a plantar plate tear:
- Sports and activities that place high pressure on the ball of the foot such as running, jumping, climbing stairs, gymnastics, and dancing.
- Over pronation (people with flat feet and low arches)
- Bunions and hammertoes
- A longer 2nd metatarsal bone (it’s more exposed to the forces that cause the injury)
- Hypermobile joints
- Tight calf muscles
- Improper shoes (on and off the field; for example, high heels place a lot of pressure on the ball of the foot)
Signs and Symptoms of a Plantar Plate Injury
If you’re noticing or experiencing any of these signs or symptoms you may have a plantar plate tear.
- Persistent pain and swelling in the ball of the foot that extends to the affected toe joint.
- Increased pain with weightbearing activities
- Increased pain with high heel wear, flexible footwear, and walking barefoot
- Reduced pain with rest
- Swelling and redness on top of the foot
- Clawed toes
- Separation of the toes with the 2nd toe moving toward the big toe called the Churchill sign
- A feeling of walking on the bones of the foot
Plantar Plate Treatment
Initially, you’ll want to relieve the pain caused by a plantar plate tear. Fortunately, there are several things you can do on your own including:
- Avoiding any activities that bring on the pain or make it worse (it can take 3-4 months for this kind of injury to heal)
- Avoid walking barefoot
- Avoid high heeled shoes, flexible shoes, and flip flops
- Take anti-inflammatory medications (be sure to check with your doctor before starting them)
- Use the RICE protocol – this protocol is an important treatment for any acute injury. It includes rest, icing (20 minutes on and 20 minutes off) several times a day, compression, and elevation.
In the office I’ll do the following treatment:
- Strapping - a special kind of taping of your toes, called plantar flexion taping, to reduce the load on the injured joint.
- Provide a boot – a boot can help reduce the movement of the joint.
- Orthotics – once your injury is healed we’ll talk about whether you need orthotics to correct your foot mechanics and prevent reoccurrence
- Metatarsal pad – a metatarsal pad can also assist in overloading the joint that was injured to prevent reoccurrence.
- Stretching the calf muscle – we recommend using an Achilles splint to stretch your calf muscle.
- Shoe gear – it’s important to wear supportive shoes to prevent a reoccurrence of this injury. Choose shoes with a stiff sole or a rocker sole. A good example of an athletic shoe with a rocker sole is Hoka.
