December 11, 2019

Why You Shouldn’t Ignore Ball-of-Foot Pain

A tear in the stabilizing structure under your foot is a common cause

Ball of feet pain

Pain in the ball of the foot and swelling on top of the foot are symptoms of a condition that’s both common and often misdiagnosed. The condition — called a plantar plate tear — can happen either suddenly or as a result of chronic, repetitive stress over time.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

The plantar plate is a fibrous structure under your foot that supports and stabilizes the joints between the toe bones and the bones of the foot. (These are the metatarsophalangeal joints).

Made up of collagen, the plantar plate consists of bands that provide attachments for ligaments that go to each toe and that go between toes. These keep your toes straight (preventing them from drifting up) and also in alignment (preventing them from separating).

“The plantar plate is implicated in forefoot pain much of the time,” says podiatrist Georgeanne Botek, DPM.

What causes a plantar plate tear?

There are 3 causes of plantar plate tears, Dr. Botek says:

Structural. A bunion or crossover deformity (when one toe crosses over the one next to it) can put added pressure under the foot.

Traumatic. “A plantar plate can tear from an injury, like tripping over a dog’s leash or your are running and all of a sudden you feel a sharp, shock-like, stabbing sensation across the ball of the foot,” Dr. Botek says.

Advertisement

Chronic, repetitive stress. With age, the plantar plate can wear down and be susceptible to tearing. Any active adult (usually over age 45) can have a plantar plate tear. But people who spend a lot of time on the balls of their feet (think: working on ladders or wearing high heels) and those who bend their toes a lot are susceptible.

The most common site for a plantar plate tear is under the second toe, but it can happen under any toe.

Why plantar plate tears are often misdiagnosed

Even though plantar plate tears are common, they aren’t always recognized. “It’s not unusual for someone to go many months and not realize this is the source of their pain,” Dr. Botek says.

A plantar plate may be misdiagnosed as:

  • A neuroma (a pinched nerve).
  • Metatarsalgia (inflammation in the ball of the foot).
  • Arthritis.

How to find relief from a plantar plate tear

Plantar plate tears are diagnosed with a physical exam, medical history and X-rays. An MRI or ultrasound may also be used.

Advertisement

Treatment involves placing and holding the affected toe in a position that allows the tear to heal. “I flex the toe 10 degrees, bringing it lower than the adjacent toe, so the edges of the torn plantar plate come together. Then, I crisscross tape along the bottom of the foot to hold the toe down,” Dr. Botek explains.

There are also splints that can be used to hold the toe in this position. It typically takes three to six months to heal. Dr. Botek advises patients to wear stiff-soled shoes and shoe inserts with metatarsal pads.

If these measures don’t help or if a deformity has already formed, surgery is an option. It’s often done in conjunction with surgery for other foot deformities.

Related Articles

Person wearing toe separators.
September 19, 2022
3 Reasons To Try Toe Separators or Spacers

Toe spacers and separators can add some comfort, but they’re not a fix-all

Person applying a bandaid to their heel in a shoe
September 1, 2022
Should You Use Numbing Spray To Wear Uncomfortable Shoes?

Dulling feeling in your feet could cause problems

A person reaches for their foot after experiencing foot pain.
May 12, 2022
Why Your Feet Hurt When You Wake Up in the Morning

You might have plantar fasciitis, Achilles tendinitis or arthritis

A runner leaning against a wall holding their knee
October 27, 2020
The 6 Most Common Running Injuries (Plus How to Treat Them)

How to spot and recover from running injuries

Woman Shoe Shopping
August 2, 2020
7 Questions You May Be Afraid to Ask About Stylish Shoes

Pick shoes that make your feet happy and are good for your overall health

Woman massaging foot due to pain
November 12, 2019
6 Reasons You Shouldn’t Assume Foot Pain Is a Heel Spur

Heel spurs aren’t the only culprit when it hurts to walk

Top view of person sitting in bathtub with cold water and lots of ice.
November 26, 2023
Brrr! What To Know About Cold Plunges

An ice bath can ease sore muscles and decrease inflammation after a workout

Person working on computer with hurting wrist.
November 23, 2023
11 Exercises and Stretches for Wrist Pain

Wrist flexor and extensor stretches are the best stretches for wrist pain

Trending Topics

glass of cherry juice with cherries on table
Sleepy Girl Mocktail: What’s in It and Does It Really Make You Sleep Better?

This social media sleep hack with tart cherry juice and magnesium could be worth a try

Exercise and diet over three months is hard to accomplish.
Everything You Need To Know About the 75 Hard Challenge

Following five critical rules daily for 75 days may not be sustainable

Person in foreground standing in front of many presents with person in background holding gift bags.
What Is Love Bombing?

This form of psychological and emotional abuse is often disguised as excessive flattery

Ad