What Is the Plantar Plate?
Have you ever felt as though there is a pebble, marble or something bunched up underneath the ball of your foot, even though there is nothing there? One possible cause is a plantar plate injury.
The plantar plate is a strong ligament-like structure underneath the joints where your toes meet your foot. It plays an important role in stabilising the toe and preventing it from lifting or drifting out of position. Plantar plate injuries most commonly affect the second toe joint.
Importantly, the plantar plate is different from the plantar fascia, so a plantar plate injury is not the same condition as plantar fasciitis.
What Does a Plantar Plate Injury Feel Like?
Symptoms commonly include:
- Pain underneath the ball of the foot, often beneath the second toe
- The feeling of walking on a pebble or marble
- Swelling or tenderness around the base of the toe
- Pain when walking barefoot
- Pain during push-off when walking or running
- Difficulty gripping the ground with the affected toe
- Gradual lifting, separating or drifting of the toe
As the injury progresses, the toe may start to lift away from the ground or move towards another toe. A noticeable V-shaped gap between the second and third toes can be a sign of increasing instability.
Why Does It Happen?
Plantar plate injuries can occur gradually through repetitive loading of the forefoot, or occasionally following an acute injury. Certain foot structures, including a relatively long second metatarsal, can increase susceptibility.
Symptoms may become more noticeable following an increase in walking, running or exercise, or during activities and footwear that place increased pressure through the ball of the foot.
Getting the Diagnosis Right Is Important
Not all pain underneath the ball of the foot is a plantar plate injury. Similar symptoms can occur with:
- Intermetatarsal bursitis
- Morton’s neuroma
- Metatarsal stress injury
- Joint capsulitis or synovitis
- Corns and callus
- Arthritis
A podiatry assessment may include examination of the painful area, assessment of toe stability, foot posture, walking pattern and footwear.
Where required, ultrasound or MRI may be used to assess the plantar plate and rule out other causes of forefoot pain. MRI is particularly useful when determining the extent of an injury, while diagnostic ultrasound can provide a dynamic assessment of the area.
Can Plantar Plate Injuries Be Treated Without Surgery?
Many plantar plate injuries, particularly when identified early, can initially be managed conservatively. Treatment aims to reduce pressure through the injured area and improve stability of the toe while symptoms settle.
Treatment may include:
- Activity and load modification
- Supportive, stiffer-soled footwear
- Strapping or splinting the affected toe
- Padding and pressure offloading
- Custom foot orthoses where appropriate
- Gradual return to activity
- Rehabilitation based on the individual’s foot function and activity requirements
Persistent pain, significant instability or progressive toe deformity may require referral for a surgical opinion.
Early Treatment Matters
A plantar plate injury can progress from pain beneath the toe to increasing joint instability and toe deformity. Early assessment therefore gives us the best opportunity to reduce load, protect the joint and prevent the problem from progressing.
If it feels like you are walking on a pebble, particularly underneath your second toe, it may be worth having it assessed rather than simply hoping it goes away.
Book an Assessment
At Highett Podiatry, our podiatrists can assess forefoot pain, determine the likely cause and develop an individual treatment plan to help you return to comfortable walking and activity.
Book an appointment or call us on 9555 3044.
Highett • Mentone • Clarinda