Have you ever experienced a soreness underneath the ball of your foot that was often hard to describe? Did the sensation feel like a burning hot press up along the inside of the bones of your foot? Has it left you hobbling or altered the way that you walk? If your answer is yes, then it is quite possible that you may have experienced an injury to an often overlooked structure called the ‘plantar plate’. In this blog, we will look at what makes this structure so vital to the functioning of the foot and how potential injuries can come about and what can be done about it.
What is the plantar plate?
The plantar plate is a structure made up of thick fibrous ligament like structures that work to stabilize the bones and structures that make up our forefoot region. The primary focus of the plantar plate structure is to
- Stabilise the toe joint.
- Assist with proper shock distribution through the arch and resists excessive forces.
- Resists deviation of the digits and prevents hyperextension of the toe joints.
As can be seen from the diagram, the plantar plate structure is indeed a complex compartment with quite an important function.
Next let’s explore what can cause an injury to this structure.
Causes of injury
Looking at the nature of the injury and the sites at which they tend to occur, it is widely accepted that an injury to the plantar plate is the direct result of overuse and overload of the structures supporting the metatarsals. The direct causes can be multi-factoral and it is always worthwhile seeing a professional for an assessment, however some common culprits include:
- Having a bunion.
- Having a hammertoe/s.
- Feet that roll in (pronate) excessively when walking or running.
- Flat feet/low arches.
- Having a short big toe or an excessively long second toe.
- Constant use of high heeled or unsupportive footwear.
- Participating sports or physical activity that requires continuous pressure along the forefoot region e.g. netball, soccer, tennis etc.
Symptoms indicating injury
Like most inflammatory or overuse injuries, there is associates pain and inflammation. The level of pain experienced will depend on the extent of the injury. Since the plantar plate structure assists in stabilizing the toe joints, injuries to this region can be classified as: a strain, a partial tear, complete tear with no dislocation and complete tear with dislocation of the associated joint.
The symptoms commonly associated with a plantar plate injury include some of the following:
- Pain and swelling underneath the ball of the foot.
- Pain may radiate into the toes and can often be described as a ‘burning’ pain.
- Pain is elicited when the toes are flexed upwards or when a person standing in the ‘tip-toe’ position.
- There may be deviation of the toes from their regular positions or even ‘splaying’ of the toes or even a depression of the forefoot.
How is the condition treated?
The first step to achieving a favourable result for sufferers is to achieve an accurate diagnosis of the condition. This may involve a combination of both x-ray and ultrasound imaging. In extreme cases, an MRI scan may be utilized to help improve diagnosis. Once a diagnosis is made the initial course of treatment would include
- Icing the affected region and/or using anti-inflammatory painkillers
- Cushioning the forefoot to reduce the levels of pressure felt across the structures.
- Digits that are displaced or depressed can be taped into position using simple physio tape which will assist in maintaining proper function.
- Altering footwear.
- Rest from training or change to training methods.
- Using custom orthotics to help correct for the effects of causative factors such as bunions and pronation.
In extreme cases where dislocation of the joint has occurred due to a rupture in the plate, a surgical referral would be warranted. Prognosis is good and within 6-8 weeks people are able to return to everyday activities and a slow progressive training increase.
Dr Anel Kapur (Podiatrist)