Pain under the ball of your foot that just won’t settle? Does your second toe feel swollen, tender or as if it’s drifting away from its neighbour? You may have a plantar plate tear, a common but often missed cause of forefoot pain.
What is a plantar plate tear?
The plantar plate is a strong ligament underneath the joints at the base of your toes (the lesser metatarsophalangeal joints). It supports the joint and keeps the toe in line. A plantar plate tear happens when this ligament becomes damaged, usually through repeated overload rather than one injury. The second toe is the most commonly affected.
Plantar plate tear symptoms
- Persistent pain under the ball of the foot, often spreading towards the toes
- Swelling under the ball of the foot and sometimes on the top of the foot
- Redness around the affected joint
- A “V sign”: a gap opening up between the second and third toes as the toe starts to drift
- Pain that feels like walking on a stone or a bruise
What puts you at risk of a plantar plate tear?
Several things can make the plantar plate more likely to tear:
- Over-pronation, where the feet roll inwards
- A bunion or hammer toe
- A long second metatarsal bone
- High-pressure activities that load the ball of the foot, such as running and dancing
Who is most likely to get a plantar plate tear?
Plantar plate tears are most common in women aged 50 and over. Hormonal changes around peri- and post-menopause, including lower bone density and reduced collagen production, can make the ligaments and other structures in the feet more vulnerable to injury.
How are plantar plate tears treated?
Most plantar plate tears are treated without surgery. A combination of treatments usually works best:
- Footwear changes: a stiffer sole and roomier toe box to offload the ball of the foot
- Strapping the affected toe to support the joint while it settles
- Stretching and strengthening exercises for the foot and calf
- Weight management to reduce load through the forefoot
- Custom foot orthotics to redistribute pressure away from the injured joint
If conservative treatment doesn’t work, surgery may be an option for severe cases, and we can refer you on if needed.
When should you see a podiatrist?
Book an assessment if pain under the ball of your foot has lasted more than a couple of weeks, if your toe is starting to drift or lift, or if swelling isn’t settling. Early treatment gives the ligament the best chance to settle and can help stop the toe from drifting further.
Frequently asked questions
Can a plantar plate tear heal on its own?
Mild tears often settle with the right offloading, footwear and strapping. Without support, though, the toe can keep drifting, so it’s worth having it assessed early.
Is a plantar plate tear the same as Morton’s neuroma?
No, although both cause pain in the ball of the foot. A neuroma involves a nerve between the toes and often causes burning or tingling, while a plantar plate tear affects the ligament under the joint. A podiatrist can tell the difference with a hands-on assessment.
Book an assessment in Ballsbridge
If you think you might have a plantar plate tear, our podiatrists can assess your foot, confirm what’s going on and build a treatment plan with you. Call 087 408 2002 or book online. Waldron Podiatry, 56 Lansdowne Road, Ballsbridge, Dublin 4.