Ball of the Foot Pain and its Causes
Metatarsalgia is a medical term used to describe pain in the ball of the foot. It is a common complaint that many patients seek treatment for. There are several potential causes of pain in this area, including corns, loss of forefoot fat pad, intermetatarsal bursitis, arthritis, stress fractures, plantar plate tears, and Morton’s neuroma. It can be challenging for patients and even doctors to differentiate between these conditions. Accurate diagnosis should be left to foot and ankle specialists. Conservative treatments such as orthotics, ice, rest, and NSAIDs are often the first line of treatment for many of these conditions. However, some conditions require specific and unique treatment approaches.
What is Plantar Plate Tear
Plantar plate tears are a common cause of ball of the foot pain. These tears most commonly occur at the joint where the second toe connects to the foot, but they can also occur at the third and fourth toes with less frequency. There are two primary causes of these tears. The first is a traumatic incident, such as hyperextending or stubbing the toe. The second cause is a progressive injury that develops over time due to improper foot biomechanics. Patients with a long second metatarsal are more likely to experience this type of injury. Bunions can also lead to abnormal pressure being applied to the second metatarsophalangeal joint leading to a plantar plate tear.
Symptoms of Plantar Plate
Patients with a plantar plate tear often experience pain and swelling in the ball of the foot, specifically beneath the second toe. They may also notice changes in the alignment of their toes, such as hammer toe or a cross-over toe deformity. In severe cases, the toe may even appear to be dislocated or raised and even cross over the big toe. Conservative treatments for plantar plate tears include immobilization, metatarsal pads, the use of stiff-soled shoes, taping or splinting, and over-the-counter pain medication. These treatment methods are typically employed first, with surgical intervention being a last resort. It is important to note that early diagnosis and treatment can increase the success of conservative treatment methods.
Biomechanics and Plantar Plate Injury
The plantar plate is a fibrocartilage tissue that connects the neck of the metatarsal to the bottom of toe, providing primary stability to the joint in the sagittal plane. Individuals with a longer second metatarsal are more prone to plantar plate injuries as the extended toe exerts greater pressure on the plantar plate, leading to its gradual weakening. Additionally, bunions can also contribute to plantar plate injuries. The ligaments called the collateral ligaments on either side of the toe can also be injured leading to the toe drifting toward the adjacent toes.
Diagnosing the Condition
Plantar plate tears can be diagnosed by taking the patient’s medical history and performing a physical exam. A drawer test is often used during the physical exam to diagnose the tear. This test involves the physician stabilizing the metatarsal and applying dorsal pressure to check for stability in the toes. Another sign of a plantar plate injury is the toe drifting toward an adjacent toe. In addition to the physical exam, MRI and ultrasound imaging can be used to confirm a plantar plate tear diagnosis.
Plantar Plate Surgery
To repair the plantar plate tear, the surgeon makes an incision on the top of the foot over the affected toe. The metatarsal bone is then cut and shortened to decompress the joint, thus addressing the underlying biomechanical issues. Afterward, the plantar plate is repaired with suture to the base of the toe through bone tunnels.
Dr. Flint, a board-certified foot and ankle orthopedic surgeon is proficient in the treatment of plantar plate tears and other foot and ankle injuries. Additionally, the team is trained in diagnosing and treating metatarsalgia and other types of forefoot pain. If you are seeking relief from foot pain and wish to resume your daily activities without discomfort, we are here to provide the necessary treatment and care.