In this case study we discuss one of the many causes of pain in the ball of the foot
I recently had a visit from a lady in her 50’s, who was complaining of severe pain in the ball of the 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. She was suffering from a plantar plate tear.
Plantar plate tear
The plantar plate 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. This 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.
How is it treated?
Treatment initially consisted of icing, strapping of the painful toe, padding to reduce the amount of pressure affecting the joint. We also advised a stretching program for her calf muscles.
The patient returned to the clinic a week later reporting that her symptoms had much improved. We then manufactured a specially designed insole 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.
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