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The plantar plate is a thick ligament on the bottom of the foot between the base of the toe and the metatarsal that keeps the toe in joint. The plantar plate keeps the toe in line and prevents it from over extending or drifting.

Plantar plate ruptures happen most commonly in the second toe. They are a progressive form of capsulitis, which is an inflammation of the plantar plate tissue. As capsulitis progresses, the plantar plate can tear, causing persistent pain and swelling.

Pain is typically felt in the ball of the foot, below the 2nd toe.

Symptoms of a plantar plate tear can include:

• A dull ache or sharp pain in the ball of the foot.
• The feeling that there is not enough cushion between the foot bone and the ground.
• Possible swelling and/or redness on the foot near the toe.
• Pain worsening when flexing the toe upwards.
• In more advanced injuries, the toe may shift upwards or to one side, resulting in “crossover toe.”

Plantar plate rupture can be caused by a specific and sudden injury to the toe and joint (acute) or repeated overuse (chronic) such as walking, running or jumping. Certain conditions, such as a severe bunion, a second toe that is longer than the big toe, or flat feet, can also make a person more prone to plantar plate injuries. Plantar plate injuries are typically more common in women in their 30’s and 40’s.

Treatment
Like most foot injuries, the earlier we can treat you, the better. Treatment of a plantar plate rupture can vary according to the degree of injury, but can include:

• Anti-inflammatory medication, ice and rest.
• Footwear modifications.
• Custom orthotics
• A walking surgical boot or shoe to keep weight completely off the ball of the foot.
• Surgery to repair the ligament, if the rupture is severe.

When it comes to plantar plate conditions, an ounce of prevention really is worth a pound of cure! Examining and diagnosing abnormal foot mechanics early on can help prevent plantar plate injuries.

– Dr. Frank, 541-385-7129

Do you ever have slight pain or a feeling that you have something in your shoe or your sock is bunched up, near your forefoot and toes? Yet when you check, there is nothing there of concern. You may have a Morton’s neuroma.

A neuroma is a thickening of the tissue that surrounds a nerve. Morton’s neuroma is the most common type of neuroma in the foot and occurs between the third and fourth toes. Neuromas are caused by compression or irritation of the nerve, which can be brought on by a variety of biomechanical issues that increase the pressure or compression on the forefoot, or by footwear that causes the toes to be squeezed together. Shoes with a tapered toe-box or high heels can cause that compression.

Symptoms can range from that “something is in my shoe” feeling, to pain, tingling, burning or numbness in the forefoot or between the toes. Although the exact causes of neuromas continue to be academically disputed, the following preventative steps may help:

• Wear shoes that have enough room in the front part of the shoe so your toes are not compressed together.
• Wear shoes with adequate padding in the ball of the foot.
• Seek a biomechanical foot evaluation to determine if your foot type is predisposed to neuromas.

If you do have a neuroma, treatment approaches vary according to the severity of the problem. For mild to moderate neuromas, treatment may include:

• Padding the metatarsal arch to lessen pressure on the nerve.
• Modified or reduced activities.
• Shoe modifications to reduce compression and reduce forefoot stress.
• Injections have proved very successful in permanently relieving the pain.

Surgery may be necessary for those who have not responded adequately to reasonable conservative measures.

If you have pain or strange feelings in your forefoot, check in with me for an appointment to rule out a neuroma.

Dr. Frank, Northwest Foot Care
541-385-7129