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Plantar Plate Injuries

What in the heck is a plantar plate injury? I can tell you it is a commonly misdiagnosed condition in my profession and one that if it is not treated early can end up needing surgery. The pain with a plantar plate injury is underneath the toe next to the big toe and can either start suddenly with a sharp pain or can come on gradually over time. In either case which you end up with is pretty constant pain under the ball the foot if it is not treated.

So what is a plantar plate? Well, the plantar plate is the supporting structure (a ligament to be exact!) that lives against the joint underneath where the toes connect to the rest of your foot. It helps to hold the toes in proper alignment. When it is injured or torn, you end up with pain and you can also end up with the toe moving out of place.  The plantar plate that injures most commonly is the one to the second toe (the toe next to the big toe). So begs the question, what could ever cause this small structure to become injured? I am in the mood to get technical, so let’s get into the nitty gritty!

One of the reasons a plantar plate can get injured is as a result of plain old genetics, i.e. specifically what type of foot you where born with. If you’ve noticed (or are noticing now for the first time!) that your toes bend up right where they connect to the rest of your foot and the tips of the toes curl down, then more likely then not, you have the foot I am talking about! This is a foot with hammertoes! These types of toes put pressure on the balls of the foot. Stay with me. The bones connecting the toes to the foot are called the metatarsals and the second metatarsal connecting to the second toe is longest. This means it gets the most pressure from toe pushing on top of it. This pressure over time can cause the plantar plate to stretch out and this make the toe unstable. This instability causes pain. People with a high arched foot can get the same result again from the increased pressure under the ball of the foot.

Another reason for injury is simple wear and tear. Anyone who exercises can injure the plantar plate. The chronic hard impact on your feet over time can wear the poor little guy out! Any form of chronic impact or strain on the ball of the foot can give you this type of injury. To give you an example, I have seen a plantar plate injury in someone in marching band and in a UPS guy who is constantly putting pressure under the ball of his feet from squatting and lifting heavy packages!  Women who wear high heel often can end up with this injury! Crazy but true!

Alright then, how do we make it go away? Getting to a podiatrist quick! To be honest, healing a plantar plate injury is very difficult. But the sooner you have it diagnosed the easier it is to control the pain. Notice how I didn’t say cure. Once you have a plantar plate injury, you are always more prone to injuring it over and over. With proper support, off-loading (taking the pressure off the ball of the foot) and even sometimes through physical therapy, we can get to stop hurting. If you are one of the unlucky ones where this does not happen, then you may end up needing surgery to tighten or repair and stabilize the ligament. Don’t assume your pain will go away on its own. If this is any incentive, see your podiatrist today!!