In this case study we discuss one of the many causes of forefoot pain
I recently had a visit from a lady in her 5o’s, who was complaining of severe pain affecting the ball of her right foot. The pain was so severe that she was having trouble walking and was complaining that even putting a shoe on was painful. There was no history of trauma and she told me that the pain was like walking on a stone. As you can see from the photo below, she had a bunion and the 2nd toe no longer sat flat on the ground.
Her trouble was being caused by injury to her ‘plantar plate’ which is a thickened fibrocartilaginous structure (similar to ligament) that attaches the toe to the foot. Patients suffering from this condition will generally complain of pain under the 2nd toe joint that is made worse by going on tip toes, walking/running or standing for long periods. As was the case in this example, plantar plate injury usually occurs from repetitive stress from abnormal forefoot loading resulting from hallux valgus (bunions), excessive pronation, short first metatarsal or long second metatarsal.
Treatment initially consisted of icing, strapping of the painful toe, padding to reduce the amount of pressure affecting the joint and stretching of her calf muscles. The patient returned to the clinic a week later reporting that her symptoms had much improved. I then took a cast of her feet and manufactured a specially designed insole (below) to reduce the stress on the joint.I reviewed her again 4 weeks later and she was delighted to report that her pain had completely resolved. This is a common condition that I treat regularly in clinic. If it is caught early, conservative treatment (as described above) is very successful and the need for further intervention like surgery is greatly reduced.