Are you experiencing pain in the ball of your foot or (forefoot) while walking or exercising? If so, then you may be suffering from a condition called Plantar Plate Dysfunction. Our forefoot is a very intricate part of the foot. There are many small ligaments, bones and muscles that hold our forefoot intact and allow for efficient, forward movement during gait (Propulsion). As we walk or run, we disperse all of our body weight from the heel (Hindfoot) to the small, ball of the foot (Forefoot).
All of the structures in the forefoot are strategically aligned to endure the stress of our body weight and convert it into efficient gait. This area receives high pressure and stress from everyday use; therefore, it is common to experience different problems such as, Plantar Plate Dysfunction, which may result in pain within this area.
Unfortunately, this is commonly missed and often mistreated by foot and ankle specialists. It can be misdiagnosed as a neuroma, bone pain and joint inflammation. Having been Fellowship trained by an innovator of treating this specific condition (Dr. Lowell Weil, Jr.), I wrote this blog to differentiate this condition from other causes of forefoot pain.
What Is a Plantar Plate and Plantar Plate Dysfunction?
Plantar plate dysfunction is a common problem associated with the dysfunction (stretch or tear) of a ligament within the forefoot called the Plantar Plate. The Plantar Plate is a ligament which is present in the lesser toes and attaches the base of the toe to the metatarsal on the plantar surface. This ligament creates a sturdy connection that prevents the bases of the toes from elevating and slipping out of the joint where it articulates with the metatarsal. This ligament stabilizes the toes with every step you take. When you step forward, your toes bend and after you lift your foot off the ground, the toes are brought back into a straight, articulated position at the joint by the action of this ligament.
What Are the Symptoms of Plantar Plate Dysfunction?
When the Plantar Plate is stretched or torn common symptoms include:
- Most common to experience problems associated with the Second Sub-Metatarsal and under the base of the toe
- Sensation of pain in the joint and at away from the ball of the foot.
- Pain most intense during propulsion phase.
- Constant dull ache at the toes
- Partial Dislocation of the joint when the Plantar Plate is completely torn.
The severity of pain is typically associated with the severity of damage to the Plantar Plate. Many factors can cause a plantar plate dysfunction, but the most common causes are associated with overuse and excessive pressure on the ligament and/or joint.
Are You at Risk of Plantar Plate Dysfunction?
Plantar Plate dysfunctions are more common see in:
- Patients with who have Long 2nd Metatarsals
- Overweight patients
- Patients who Overuse and Abuse the Area (Wearing high heels and Excessive stress exercise).
- Patients with Bunions
- Tight Fitting Shoes.
It is important to take care of your feet and treat a plantar plate dysfunction as early as possible because if left alone, can lead to more severe problems such as: Hammertoe (Deformation/Buckling of the toe), deviation of the toe, progressive instability of the toes, continued pain and arthritis.
Prevention of a Plantar Plate Dysfunction includes:
- Early diagnosis by a podiatric foot and ankle specialist and assessment of pain that arises at the ball of the foot.
- Controlled, mild workouts and exercise.
- Wearing properly fitted shoes with good support.
Treatment of Plantar Plate Dysfunction includes:
- In mild cases, padding within the shoes or orthotics are made to stabilize the foot.
- Strap toes together to stabilize the movement of the injured Plantar Plate.
- Rest and take pressure off of the injury as much as possible.
- In severe cases, instability and/or complete tears, surgery may be required.