Pain at the ball of the foot is very common and may be instigated by a variety of problems. Plantar plate injury or tear may be a cause of such pain. The plantar plates are firm fibrocartilaginous structures that are essential for the stability of metatarsophalangeal and interphalangeal joints. Plantar plate tears are a type of joint capsular tear of the metatarsophalangeal joint. The stability of the joint can be compromised if an injury occurs to the plantar plate, resulting in an unstable toe, hammering of the toe, or other toe deformities.
Patients commonly present with pain under the 2nd metatarsophalangeal joint. Plantar plate injuries or tears may be acute or chronic. An acute injury tends to result from trauma, causing a swift and extreme upwards motion of the toe that may later be accompanied by pain, swelling and bruising. Patient’s may feel a tearing sensation; the toe may possibly dislocate upwards and may be relocated. Chronic injuries are more common and result from the plantar plate and involved ligaments undergoing microtrauma and repetitive stress. Chronic injury to the plate is commonly a result of a biomechanical imbalance of the foot where repetitive stress causes recurrent tearing. The most common etiology being an elongated metatarsal or a short neighboring metatarsal.
Depending on the severity of the injury and instability of the joint would determine the treatment. For chronic injuries, non surgical treatment options would be aimed toward symptomatic relief. Treatments would include: NSAIDs, offloading, activity modification, orthotics, toe splinting or pads, rocker-bottom shoes or corticosteroid injections. The only definitive treatment for a progressive deformity would be surgery. Call your podiatrist today if you have questions or concerns about plantar plate injuries.
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