The second toe is the most common toe to dislocate in the forefoot. The plantar plate at the second metatarsophalngeal joint can become unstable and rupture causing pain, swelling and subluxation or dislocation of the toe. The plantar plate attaches the bottom of the metatarsal (long bone in the foot) to the base of the proximal phalanx (toe bone) and prevents motion in the sagittal plane and absorbs shock while ambulating. It is a major stabilizing structure and when damaged can lead to a crossover toe.
Plantar plate tears are caused by trauma, inflammatory arthropathy, and repetitive hyperextension commonly caused by excessive wear of high heels.
Patients often complain of pain and swelling on the bottom of the toe. Without treatment the deformity can progress and the second toe can cross over the big toe making it difficult to wear shoes.
Foot& Ankle Doctors, Inc
will perform an anterior draw test, which is pathognomonic for an unstable metatarsal phalangeal joint. Ultrasound, x-ray and MRI are other diagnostic tests that may be ordered to determine the severity. Conservative treatment includes:
-Rest
-Ice
-NSAIDs
-Taping the toe in a plantarflexed position
-Accommodative padding to reduce pressure under the affected toe
-Stiff-soled shoe or rocker-bottom shoe
-Custom orthotics
In severe cases the plantar plate may need to be surgically repaired. The plate itself may need to be sutured or a metatarsal osteotomy performed to shorten the second metatarsal.
If you are having pain in your toes, come see us at
Foot& Ankle Doctors, Inc