Plantar Plate Injuries
Are you experiencing pain under your 2nd toe(lesser toe) when walking? Have you noticed a slight gap between your 2nd and 3rd toes? You may be suffering from a plantar plate injury. The plantar plate is a thickening of the joint capsule found under each of the bases of the lesser toes. This structure is responsible for stabilizing the lesser toes, helping you push off from your toes when walking, and preventing the very common “hammertoe” deformity. Injuries to the plantar plate can be caused by poor shoes such as high heels, walking barefoot on hard surfaces, and impact exercises such as running. As many of us have spent a lot more time at home lately, these risk factors have become increasingly more common.
Anatomic location of the plantar plate (for more information click here)
Although most often diagnosed solely by clinical exam, there are several non-invasive tests that can be performed to help differentiate a plantar plate injury from the Morton’s Neuroma. Typically, a patient will complain of neurological symptoms in the presence of a neuroma (tingling, burning, or radiating nerve-like pain which may travel to the toes). A simple x-ray in the office can be utilized to rule out other potential pathologies such as a stress fracture or arthritic problem in an adjacent joint. A diagnostic ultrasound or MRI may be obtained to confirm the injury. Additionally, a diagnostic injection may be a useful toll in making the diagnosis.
Typically noted at the base of the second toe, symptoms include pain and swelling under the affected digit when walking, possible deformity of the affected toe, and pain with range of motion of the digit. It may be noted that the second toe is starting to abut or even overlap the big toe. In severe cases, dislocation of the toe with a clawed and deformed digit can occur. This often is associated with a bunion (hallux valgus) deformity, but not always. The toe deformity can become severe enough that fitting into many shoes will become difficult. Patients will usually not note any specific injury or event that preceded the symptoms.
Early diagnosis is important. Most patients with a plantar plate injury will recover with conservative treatments as long as the condition is diagnosed and treated early. Some require immobilization in a boot for a period of several weeks with a specific technique of taping the affected toe. Typically, the toe is drawn downwards to help stabilize the damaged ligament while it heals. Increasing the blood supply to the damaged ligament is paramount to ensure quick healing. EPAT (Extracorporeal pulse activation technology) is a highly effective treatment which increases blood flow and brings in the body’s own growth factors to help the injury heal quickly. Patients often feel improvement in a few short weeks. Orthotics can be greatly beneficial in many cases to help support the area as well. These are typically custom made to an individual patient’s foot and have added support in the forefoot region and often a cut-out underneath the affected toe. Anti-inflammatories or oral steroids may also be helpful in the early stages of the injury. As there are many conditions that can lead to pain underneath the toes, prompt diagnosis and treatment is paramount to a quick recovery.
Life has changed drastically for many of us, and new routines can unfortunately lead to new pain. With poor shoe gear, increasing impact exercises, and even faulty foot mechanics playing a role, a plantar plate injury is one that should not be ignored. If you ever experience pain on the bottom of your foot, have it evaluated immediately. No level of foot pain is considered normal, so seek treatment right away when symptoms develop to quickly get back on your feet!
Dr. David Vieweger provides care in Chevy Chase, MD and in Washington, DC (K Street). He completed his residency training at MedStar Washington Hospital Center and MedStar Georgetown University Hospital. Although all aspects of foot and ankle care interest him, he especially enjoys sports medicine and trauma. In his spare time, he frequently enjoys running in local races, biking, and baseball.
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