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Posted 5 Mar '18

Toes Separating like a ‘V’? It’s a Sign of a Plantar Plate Tear

Have you noticed that two of your toes have come out of line? Perhaps where they used to line up normally alongside one another, they’re now moving apart from one another like a ‘V’. This is actually something we refer to as the ‘V Sign’, and more often than not, it’s linked to a plantar plate injury at the ball of your foot. Because plantar plate injuries can not only cause a fair bit of tenderness but also interfere with the alignment of the toes which can worsen over time, our team at Perform Podiatry thought we’d get you familiar with the ins and outs of plantar plate tears, so you know what to look out for!

The Basics: What is Your Plantar Plate?

The plantar plate ligament is a thick band which runs across all of the toe joints at the ball of the foot, attaching to and connecting all five toes. The plantar plate works to protect the ends of the metatarsals (long bones of the foot), helps to absorb impact from heavy loads, stabilises the ball of the foot and keeps the joints (and toes) from separating, among other functions.

What Causes a Plantar Plate Tear?

Plantar plate tears or injuries occur when this ligament is damaged, usually from too much pressure on the ball of the foot. It usually occurs at the second metatarsal because it’s often the longest, and so takes on the most force when the toes bend during walking. Other causes and contributing factors may include:
  • Flat (rolled in) feet
  • Bunions and hammertoes
  • Short first metatarsal bone (and hence longer second metatarsal bone)
  • Repetitive high-impact activity such as running
  • Climbing stairs and similar actions that put pressure on the ball of the foot

What Does it Feel Like?

Generally, those with an injury to the plantar plate experience pain and tenderness at the ball of the foot in the affected regions. There may be some swelling and the feeling that you’re walking directly on the bone. Because the plantar plate ligament is damaged, it won’t be able to maintain the usual alignment at the ball of the foot, and the toes may drift apart, creating that ‘V’ sign. In our clinical experience, we’ve seen many patients who have previously sustained plantar plate injuries that didn’t even realise there was a serious problem. We notice the ‘V’ sign and then discover that some time ago, the patient did experience some tenderness at the ball of their foot but ignored it, thinking they had just over-exercised or had a long day on their feet and it would go away on its own. While the painful symptoms did settle, the alignment and positioning of their toes were never treated or corrected, leaving their toes in the ‘V’ position, and affecting the alignment of the rest of the toes around them.

What Should You Do?

Our approach to treatment at Perform Podiatry not only focuses on settling your painful symptoms, but also to correct the alignment of the toes and to reduce the risk of re-injury in the future. That’s why we conduct a thorough biomechanical assessment to address the causes of the injury in the first place and treat those too. Often we use strapping to help control the position of the toes, padding to alleviate pressure away from the affected toes, and orthotics to help control the position of the foot with every step to alleviate pressure and address any abnormal foot biomechanics that may have caused the problem in the first place. During your recovery, we’ll talk about your shoes to make sure they’re helping and not hindering your recovery, and we’ll look at what else is going on with your feet, such as bunions, that may be part of the problem. The good news is that with proper care, plantar plate injuries are very treatable and you can be out of pain and have your toes back in line relatively simply, following the treatment plan and recommendations from our team. If you notice a ‘V’ sign from a previous injury, we may even be able to help with that too, before the alignment of your toes worsens. Our podiatrists are experts in the biomechanical function and alignment of the feet and legs, and love seeing our patients back at their best and doing the things they love! To book an appointment, give us a call on 09 523 2333 or book online!

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