Forefoot Pain

What is the plantar plate?

The plantar plate is a thickening found under each of the lesser toes and it forms part of the joint capsule. This structure helps you push off from your toes when you walk, stabilises the smaller toes, and guards against “hammer toe” deformity.

What can cause injury to the plantar plate?

Injury to the plantar plate can be a tear, rupture or elongation of the tendon

Plantar plate injuries can be brought on by footwear, such as high heels, walking barefoot on hard surfaces, and taking part in high impact exercises like running.

All the metatarsal plantar plates can become damaged, but the 2nd toe joint (the one next to your big toe) is the most frequently affected because it is the longest and least stable and subject to overloading when the big toe is not functioning correctly.

What are the signs and symptoms?

The earliest symptom is usually pain on the top of the foot over the joint at the base of the second toe. This can radiate across the top of the foot.

Gradually the affected toe starts to ‘float’ rather than the end of the toe meeting the ground.

Walking causes pain under the base of the second toe and you may also detect a gap between the toes

Along with these symptoms, the affected toe might swell and even become malformed.

The movement of the digit during the examination may cause pain. It should be observed that the second toe is beginning to overlap the big toe slightly or even completely.

This is commonly associated with a Bunion (hallux valgus) deformity and may become difficult to fit into shoes.

Some patients recall pain immediately following an injury to the foot and this can indicate that there has been a plantar plate rupture. In these cases a surgical referral will be necessary. 

Typically we find that most patients won’t recall any particular accident or incident that occurred before the symptoms and report a more gradual onset with increasing pain. These patients are successfully treated conservatively in clinic.

We treat plantar plate problems with a combination of: 

We plan each patient’s care on an individual basis.

A plantar plate injury should not be ignored. Footwear, exercise and foot mechanics all play a part and with the right modifications symptoms can be reduced.