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!
FAQs
Symptoms can include: Pain and tenderness in the area of the tear at the ball of the foot. Swelling at the bottom and/or top of the foot. 'V' sign where the toes in the affected region have separated, resulting in a 'V' shape between the toes.
What is the V sign in a plantar plate tear? ›
This condition is common among athletes, especially those who engage in high-impact sports like running and jumping. Plantar plate tear causes the affected toe to deviate away, resulting in a “V” sign.
What does it mean if my toes are separating? ›
It has many different causes, though the most common are neuromas, plantar plate tears, ligament ruptures, and Morton foot type. Patients usually seek a healthcare provider for toe separation cases when the condition becomes painful, worsens, or is unaesthetic enough for the patient to warrant action.
What causes your toes to split underneath? ›
When skin is too moist, you may get a bacterial or fungal infection. This can cause cracks between the toes. People who often walk barefoot or wear open shoes are at risk for dry skin. People who wear shoes without socks or shoes and socks that don't breathe well are at risk for moist skin problems.
Can a plantar plate tear heal without surgery? ›
The initial step in plantar plate tear treatment typically involves conservative, non-surgical methods. These may include: Rest: Reducing activities that exacerbate pain. Anti-Inflammatory Medications: Over-the-counter or prescribed medications to alleviate inflammation and pain.
What is the V sign between toes? ›
A Plantar Plate Tear presents the beginning of a hammered or clawed toe. It is caused by an injury to the cartilage and ligaments that are attached to the base of or between the toe bones. The following are the most common symptoms of this condition: A “V” sign is made when the toes separate into a V-shape.
How to fix V toes? ›
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.
How do you fix a separated toe? ›
Dislocated toes can usually be treated with closed reduction, but sometimes an open reduction (surgery) is necessary. Closed reduction can be painful, and your doctor may give you a sedative or inject a local anesthetic to help you manage. Open reduction is a surgery done in the operating room.
Is walking good for plantar plate tear? ›
A plantar plate tear takes longer to heal than most injuries because of the force of the entire body's weight on it during normal walking. Non-surgical treatment for plantar fasciitis tear involves non-weight-bearing for 6-8 weeks as the optimal treatment.
How do you fix a plantar plate tear at home? ›
Conservative treatment options for plantar plate injury typically includes rest, icing of the injury, avoiding activities that cause or worsen the pain that you're feeling, wearing comfortable shoes that keep your toes straight and anti-inflammatory over-the-counter medication (reference: 1, 2, 3, 4, 5).
Plantar Plate Tear Treatment
In the early stages of ligament disruption, nonsurgical care can be effective. This entails identifying and eliminating the deforming activity or force. For acute cases, we may need to prescribe a boot or special shoe to keep weight off the front of the foot.
What is it called when your toes separate? ›
Symptoms of a Plantar Plate Injury
If the person attempts to raise their toes, they may experience an instant and notable increase in their pain levels. In more advanced cases, the toes may begin to cross over each other. They may also begin to separate and form into a “v” shape.
What does a toe fissure look like? ›
The most visible sign of a fissure is the appearance of a crack, tear, groove, elongated cleft, or deep burrow in the skin. There may be related irritation and discomfort if the fissure is extensive or goes deep into the skin of the foot or heal. The skin cracks or fissures may be painful if they occur between toes.
What is Morton's toe syndrome? ›
Morton's foot syndrome is a hereditary syndrome characterized by a short first metatarsal bone, posterior displacement of the sesamoids, and hypertrophy of the second metatarsal, causing excessive weight to be borne by the second metatarsal head. This condition results in callus formation under the second metatarsal.
How do you test for plantar plate tears? ›
With this test, pull the proximal phalanx dorsally with a stabilized metatarsal. More than 2 mm of displacement of the phalanx indicates a plantar plate rupture or insufficiency.
What are the grades of plantar plate tears? ›
Tears in the plantar plate are graded 0-4 based on severity. The least severe is a grade 0 where the fibers of the plate are stretched. In a grade 1 tear, less than 50% of the plate is torn, whereas in a grade 2 more than 50% is torn. Grade 3 is more extensive and involves the collateral ligaments.
What are the signs and symptoms of plantar fascia tear? ›
Here are a few sign that you've torn your fascia:
- Your arch has collapsed.
- You experience intense pain in your foot's heel or arch while walking.
- You experience pain while your toes are bent.
- You notice a painful lump/bump in the arch or heel of the foot.
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!