A subtle, but significant cause of pain in the bottom front of the foot is due to a plantar plate injury or tear. A plantar plate injury is just one of many causes of plantar forefoot pain, also known as metatarsalgia.
The plantar plate is a fibrous ligament that connects the bottom of the base of the toe to the corresponding metatarsal head. Its role is to protect and support the bottom of the joint, and it is commonly subject to considerable load and pressure. In situation where the big toe joint (1st MTP joint) is not functioning correctly, such as a bunion or osteoarthritis, this can add even further pressure onto the lesser MTP joints (such as the 2nd and 3rd), where plantar plate tears are most frequent.
In situations where there is abnormal pressure and loading on the bottom of the forefoot (eg bunion deformities), then it is not uncommon to start to develop pain and discomfort related to stress on this ligament. Over time, degeneration can occur until the point where the plantar plate can stretch, weaken and tear. Sometimes plantar plate tears are confused with neuroma’s and other causes of metatarsalgia.
If the plantar plate injury progresses to a full rupture, then considerable toe deformity can occur, and surgery is often necessary.
On assessment, patient’s can often have considerable swelling and tenderness on the bottom of the foot at the junction between the 2nd or 3rd toe, and the corresponding metatarsal head.
Usually an ultrasound scan or MRI, combined with careful physical assessment of the foot can identify plantar plate injuries.
Treatment options can include taping, orthotics, footwear modifications – all of which are designed to reduce pressure on the plantar plate and encourage healing. However, where pain fails to settle, or considerable toe deformity exists, then direct surgical repair of the plantar plate, sometimes in-conjunction with shortening of the corresponding metatarsal might be necessary.