Have you ever heard of your plantar plate?
This is a thick ligament in your foot, that runs along the ball of the foot connecting to the joints. It
protects the bottom of you metatarsals (foot bones) from excess pressure, preventing your toes from over
extending or spreading too far apart. It can develop tears from overloading or repetitive strain.
These can be particularly common in dancers and runners. You can also be more prone to
developing one if you tend to over-pronate (roll your feet inwards), have a bunion or hammer toe, or have
a particularly long second metarsal. Sometimes it can also be injured due to trauma to the toes.
Signs and symptoms include:
- There may be a history of trauma to the foot. eg. stubbing toes etc.
- Pain or swelling under the ball over your foot, sometimes extending into your toes, particularly the 2nd and 3rd.
- Swelling or redness on top side of the foot, over the toes.
- A ‘V’ sign between the toes, where they have separted further than normal.
- A feeling of instability within the bones to the forefront of the foot.
- Discomfort with weight bearing activities such as running, jumping, barefoot walking.
- Wearing heels, or unsupportive flexible footwear such as flip flops will also be uncomfortable.
- Rest and non-weight bearing may reduce pain and discomfort.
Plantar plate tears can normally be diagnosed in the clinic by your physiotherapist or podiatrist. A more acute injury may require imaging such as Xray and Ultrasound to assess the severity of the injury, paticularly if there has been an episode of trauma.
The first phase of treatment is pain relief and protection of the affected toe. This includes, strictly no barefoot walking for at least 4-6 weeks, activity modification, ice for pain relief, and protective footwear. For more traumatic or severe injury, a moonboot may be required. If the injury isn’t traumatic, and is diagnosed as an over use strain, your therapist may recommend some suitable trainers for walking/exercising in to help offload the plantar plate. Taping techniques and padding are also used to help offload the plantar plate and decrease pain.
Once the pain has settled, you will be given some suitable strengthening exercises to do, to improve intrinsic foot strength and calf function. Your therapist will also guide you on gradual return to activity and sport, and educate you on how to manage flare ups.