Ball of Foot Pain Won’t Go Away? You May Have a Plantar Plate Tear—and That ISN’T Good News

There’s an old saying in the medical world: When you hear hoofbeats in the night, look for horses. Not zebras. 

In general, that’s pretty good advice—at least when you’re first attempting to identify and diagnose a problem. If a certain set of symptoms is indicative of, say, plantar fasciitis 95 percent of the time, that’s a pretty good place to start. 

But here’s the problem: 95 percent isn’t the same as 100 percent. Though hoofbeats usually do mean horses, once in a while there will be zebras. So if you (or even your doctor) aren’t looking out for other possibilities, you might spend months (or longer!) wondering why your treatment efforts just aren’t working. 

Such is the case, unfortunately, with plantar plate tears. If you have unexplained ball-of-foot pain that isn’t going away, or you’re wondering why your “neuroma” isn’t getting better, you may instead have this oft-misdiagnosed condition. 

Plantar Plate Tear Graphic
footprint beach

What Is a Plantar Plate Tear? 

 The first step to understanding this condition, of course, is to simply know what the plantar plate is! Although the term “plate” might lead you to think of bones, the plantar plate is actually a strong ligament that sits underneath your second toe, right where it meets the rest of your foot. 

The main job of the plantar plate is to stabilize the joint at the base of that toe, which prevents it from destabilizing (and keeps the toe from drifting upward or sideways). 

Essentially there’s a “tug of war” going on between the various ligaments that support this (or any) joint, and they need to be in balance for your toe to lie straight and work properly. If the plantar plate starts to lose this tug of war, the toe can be pulled out of position. Even if this change in alignment is subtle, it can still expose the metatarsal head to excessive weight and pressure, overloading it and quickly leading to ball of foot pain. 

Because the plantar plate is exposed to a high level of stress—especially in people who enjoy a lot of athletic activity—it can easily become fatigued, overstretched, and torn. 

How Can I Tell My Ball of Foot Pain Is Caused by a Plantar Plate Injury? 

As mentioned above, the unfortunate reality is that this condition tends to be underdiagnosed. You may be told you have “metatarsalgia,” which is not actually a diagnosis but a general term for pain in the ball of the foot—which is not helpful in this case. Other very common misdiagnoses include neuromas, joint inflammation, or bone pain. But it is none of these things. 

Some characteristic symptoms especially associated with plantar plate tearing include: 

  • Aching pain in the ball of the foot, near the base of the second toe. Although this may reduce with rest, you may experience a dull ache in your toes nearly constantly. 
  • Pain that increases during weight-bearing activity, especially during push-off or propulsion 
  • Partial dislocation of the second toe (particularly if the plate has fully torn). Please note that, in very mild cases, there may be no or very little dislocation.  

If these symptoms sound familiar to you, you may have suffered a plantar plate injury. A physical examination and diagnostic imaging can help us quickly confirm whether this is the case. 

Why Does It Matter? 

Plantar plate tears are extremely serious injuries that need to be identified early, and treated very specifically, in order to prevent more severe consequences. 

From a symptom perspective, the distinction between a plantar plate tear and, say, capsulitis or joint inflammation may seem trivial and academic. But it makes a huge difference in both short-term treatment and long-term consequences. 

If the plantar plate tear worsens, there is a much greater risk that you will go on to develop severe arthritis (due to rapid wearing out of joint cartilage), joint instability, hammertoes, and other painful complications. This just isn’t the case for, say, a neuroma.  

Furthermore, there are some subtle and specific techniques that must be used to properly treat most plantar plate tears conservatively, including a special taping strategy that keeps the toe stabilized in a downward position. Again, this wouldn’t be standard practice for “ordinary” soft tissue issues, so without a proper diagnosis of a plantar plate tear it is unlikely to get better on its own, and more “general” treatments alone (RICE, roomier shoes, orthotics) are unlikely to be effective. 

If the toe dislocation becomes severe, it’s likely we’ll need to perform surgery to realign and strengthen the joint. Although this is a relatively simple surgery with a high success rate, we’re sure you’d still much prefer not having to reach that point in the first place! 

Subtle Difference Can Make a Big Difference

Zebras and horses may look a lot alike. But there’s a reason one species has been a domestic partner of humankind for thousands of years, and the other remains wild (and actually highly dangerous). They’re very different creatures, and if you try to treat a zebra like a horse, you’re likely to get bitten or kicked. 

If you are currently struggling with ball of foot pain that isn’t getting better, please don’t just shrug it off as a particularly stubborn case of “metatarsalgia.” You deserve a clear answer for what’s causing your pain, and if it is a plantar plate tear, we want to make sure you get the necessary treatment as quickly as possible. 

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