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Why do my toes look like they’ve separated?

Why do my toes look like they’ve separated?

If two of your toes resemble more of a ‘V’ shape between them instead of being immediately next to one another, this is for you. A plantar plate tear is the most common cause for this kind of toe separation - and some people may not realise that it had even occurred until they see this sign.

 

What is a plantar plate - and how has it torn?

Plantar plate tears are an injury to the plantar plate ligament - a long, thick band that runs across the ball of your foot, attaching to all five joints. Your plantar plate is meant to help:
  • Protect the joints at the ball of your foot (metatarsophalangeal joints), particularly the heads of the metatarsals from overextending when your foot bends
  • Absorb forces when you walk
  • Stabilise the joints at the ball of the foot, keeping them aligned (so they don’t move up or down) and together with the rest of your toes
  • Assist other structures, like the plantar fascia, in their function
 

 

Plantar plate tears are caused by overloading the ball of the foot. That is, excess pressure is applied to the ball of the foot, whether it is repetitive or a one-off, and the plantar plate ligament gets injured. As the second metatarsal is often the longest, it is usually affected. The injury may also be associated with:
  • Pronating (rolling in) the feet when you walk, which can put excess pressure on the forefoot
  • Bunion and hammertoe deformities, which can impact the alignment of the joints at the ball of the feet
  • A short first metatarsal bone or long second metatarsal bone, which changes the amount of pressure taken by the bone ends, with the longer bone placed under much greater stress with every step
  • Repetitive high-impact activity such as in running
  • Climbing stairs or similar activities that put excess pressure on the ball of the foot

What does a plantar plate tear feel like?

You may feel:

  • Pain and tenderness in the affected joints (likely the second toe)
  • Swelling at the bottom and sometimes the top of the foot
  • Like you’re walking directly on the bone or a stone
  • You may notice the V’ sign where the toes in the affected region have separated, and your pain may be aggravated by bending the toes upwards. We’ve also seen patients with a ‘V’ sign and no current symptoms. This may mean that they’ve damaged their plantar plate ligament in the past, likely associated with another injury, and have not noticed or rehabilitated the injury - or their pain was not severe.

 

Can I get my toes to be straight again?

The answer to this question for you specifically lies in your consultation with your podiatrist, but yes it is definitely possible if there have been no permanent bony changes.
Treating painful plantar plate tears starts with managing the painful symptoms. Rest, ice and non-steroidal anti-inflammatories like ibuprofen can help, where appropriate. 

 

Treatment then focuses on rehabilitating the plantar plate ligament, restoring the integrity of the toe alignment, and addressing the cause to help prevent this problem from recurring in the future. This may include:
  • Strapping the toes (we use a special cross strap for plantar plate tears)
  • Padding to temporarily alleviate pressure from the affected toes
  • Orthotics to correct any biomechanical or alignment issues that may have contributed to the tear, as well as off-loading the painful structures
  • Footwear assessment to ensure the shoes are helping and not hindering your recovery
  • Managing associated conditions such as bunion and toe deformities
 

 

We understand how important it is to be able to walk without pain so if you’re worried about your feet, or suspect that you have a plantar plate tear - whether it’s painful or not - we’d love to help. We’ve been helping our community in Toowoomba & Darling Downs for over 20 years. To book an appointment, call us on (07) 4638 3022 or book your appointment online here.
Our expert team will get you out of pain and back to doing the things you love.