Plantar Plate Dysfunction (Pain - Ball of the foot)

Why could I be having pain in the forefoot?

Pain in the forefoot could be for various reasons. One of the common reasons for forefoot pain is the dysfunction or tear of the plantar plate.

What is Plantar Plate?

Plantar plate is a ligament (rectangular structure) which is attached to the bottom (plantar) of the foot between the base of smaller toes and metatarsal neck. It helps in stabilising the smaller digits (toes). Plantar plate helps in keeping the lesser toes in the joint and avoids hyperextension of the toes out of the joint. During the push off phase of a gait cycle or propulsion phase, the toes will bend at the base of the joint. Plantar plate helps to keep the lesser toes in position and aids in bringing the lesser toes back to the joint post toe off.

What are the symptoms of plantar plate dysfunction?

The most common symptom is the sensation of pain at the ball of the foot or in the joint. The pain is usually described as a dull ache at the ball of the foot which usually occurs in one toe at a time. Most commonly in the second toe. The pain varies depending on the stage and severity of the tear or dysfunction. Dorsiflexion (pushing the toe up) is often painful. Pain may be felt during the toe off phase of the gait cycle as well.

In more severe cases, there will be partial dislocation of the metatarsophalangeal joint. The toe will over-ride the other toes and lesser toes will claw in.

What causes plantar plate dysfunction?

Plantar plate dysfunction is mostly caused by overuse injury or by trauma to the toe and/or the joint. Excessive pressure on a particular joint over a period of time may lead to plantar plate tear and or dysfunction.

Who can be affected by plantar plate dysfunction?

• People who have a longer second metatarsal (one of the 5 long bones in the foot)
• People who wear high heels. In such cases the toes stay in a dorsiflexed position for longer thereby increasing the load on the joints of the ball of the foot
• People with bunion(s) (Hallux Abducto Valgus)
• People with abnormal pronation of the rear foot
• Recent change in the level of physical activity

Risks

If left unattended, plantar plate dysfunction could lead to a deformed toe (hammer toe). Due to deformation of the toe, the cartilage in the joint is likely to get eroded over time. This may cause pain and could lead to arthritis.

Prevention

• Wear supportive and cushioned footwear
• Consult a podiatrist if you experience pain in the ball of the foot. Earlier diagnoses and intervention is recommended.

Treatment

Treatment depends on the severity of the plantar plate dysfunction and/or the tear of the plantar plate.

In mild cases of plantar plate dysfunction/tear, the following solutions may be help

• Strapping the digits together to plantarflex the digits
• Use of metatarsal pads in footwear
• Foot orthotics (with metatarsal pads incorporated)
• Wearing stiff soled or rocker shoes (limits dorsiflexion of the toe(s) in question)
• Corticosteroid injection if required

If the treatment outlined above does not help, surgery may be considered as an option.