When is a Hammertoe not a Hammertoe? When it’s a Plantar Plate Injury

Hammertoe vs. Plantar Plate Injury, University Foot and Ankle Institute Los Angeles

In 1709, Alexander Pope opined that “a little learning is a dangerous thing”. He meant that knowing a little bit about something may lead to overconfidence, consequent mistakes, and negative results.

In the field of podiatry, self-diagnosis can follow the same unfortunate journey. Take, for example, the condition commonly known as “hammertoe”.

What does a hammertoe look like?

The primary symptom of hammertoe is a lesser toe (i.e., not the big toe) that’s been deformed into a semi-circle. (A hammertoe, or crossover toe, actually looks more like a hawk’s talon than a hammer.)

The distorted appearance of a hammertoe can be accompanied by significant pain. This discomfort results from inflammation generated by friction between the apex of the deformed toe and confining footwear.

So, if your toe looks like a crescent moon, and it hurts a lot, the answer is simple, right? It’s got to be a hammertoe.

Well, maybe not. Your problem might very well be a plantar plate injury. The two conditions can result in identical visual symptoms, at least to the untrained eye.

What causes a hammertoe?

The potential sources of a hammertoe are numerous and varied. Hammertoes can arise from a muscle imbalance, which can be either inherited thanks to the gift of heredity or acquired. The muscle that keeps the middle joint of the toe flat on the sole of your shoe is weakened. It gives way to the stronger muscle, which tugs that middle joint upwards.

A hammertoe can also result from trauma to the toe or its surrounding structure. Inherited characteristics, such as abnormally high arches or flat feet, can also lead to a hammertoe.

Inappropriate footwear is often responsible for hammertoes. High heels shift the wearer’s weight up, forward, and onto the toes, which are often unable to withstand the prolonged strain.

The type of joint dislocation known as a bunion or hallux valgus can be another cause of a hammertoe deformity. When a bunion causes the tip of a big toe to shift towards the second toe, that neighbor toe can be levered upward.

Other conditions and diseases can also lead to hammertoes. Arthritis, diabetes, neuromuscular disorders, and stroke can all contribute to the formation of a hammertoe.

What is the plantar plate?

Plantar plates are strong bands of the resilient ligament that help to attach each of your toes (except your big toe) to its corresponding metatarsal bone. These pads of cartilage are located in the forefoot, below the joint that they connect. They’re intended to keep your toes properly aligned: straight, stable, and not intruding on their neighbors’ space.

By some anatomical quirk, big toes don’t come equipped with plantar plates. They’re usually sturdy enough to maintain their stability without that accessory.

What is a plantar plate tear?

Plantar plates are damaged by many of the same forces that cause hammertoes. For instance, the same pressures that result from wearing high heels can eventually cause a partial or complete tear of the plantar plate.

Although plantar plate tears can occur from sudden trauma, they usually develop incrementally. The plantar plate ligament typically degenerates from repetitive overuse or anatomical abnormalities, like a metatarsal bone that is too short, too long, or elevated.

What are the symptoms of plantar plate damage?

Patients with plantar plate injuries may report either a dull ache or a sharp, stabbing pain in the ball of the foot. It may feel as though you’re walking on the bones of your feet.

As the plantar plate tear progresses, the toe will shift up or diagonally. This exposes the metatarsal to bruising, which enhances the pain.

If a torn plantar plate is left untreated, it will continue to worsen, until it reaches chronic status.

How are hammertoes and plantar plate tears diagnosed?

The diagnosis of each condition begins with a physical examination. Your doctor will manipulate the affected joint to ascertain the severity of the condition.

Imaging techniques, such as x-rays and MRIs, help establish the exact nature of the problem. MRIs are particularly helpful for plantar plate cases. They give detailed visualization of the tears within the plantar plate.

What are the initial treatments for hammertoes and plantar plate tears?

Conservative treatment for both conditions is remarkably similar. Properly fitting footwear, with a wide toe box and increased arch support, are helpful for both hammertoes and plantar plate damage. High heels are, of course, to be avoided.

Toe braces, taping and strapping will take the pressure off the forefoot and affected toes.  Anti-inflammatory medicine and physical therapy can help. Custom orthotics can help. Custom orthotics redistribute weight-bearing forces affecting the tendons and ligaments that control the position of the affected toes.

Is surgical treatment available for hammertoes and plantar plate tears?

Here’s where treatment of hammertoes diverges from that appropriate for plantar plate tearsEffective surgical correction is available for each condition, but surgical remedies for plantar plate tears are considerably more complex than the techniques appropriate for hammertoe surgery.

Surgical hammertoe correction is a simple outpatient procedure, with limited downtime. The usual best option is a fusion of the bones in the deformed toe, using a next-generation implant material called OssioFiber which is an inert fiber material that slowly converts to the bone and incorporates into the fusion site.

In a limited number of hammertoe cases, the preferred option is an arthroplasty, removal of the small portion of the bone in the deformed toe.

For plantar plate tears, the surgeons of UFAI have collaborated directly with podiatric researchers in the development of a revolutionary plantar plate repair technique called the HAT-TRICK.

Dr. Baravarian explains the HAT-TRICK technique that has revolutionized plantar plate repair surgery.

Because plantar plate tears almost always require correction of the surrounding structure, as well as repair of the plate itself, the HAT-TRICK uses a comprehensive approach that includes three distinct elements.

In many cases, the collateral ligaments, located on the sides of the affected toe, have also incurred damage. The HAT-TRICK protocol repairs those collateral ligaments. It also incorporates an implant that eliminates the toe deformity.

In certain cases, the plantar plate is to badly damaged that it cannot be repaired. In such cases, a flexor tendon transfer is performed to reconstruct the plantar plate. The flexor tendon on the bottom of the associated toe is split and repaired on the top of the toe under tension which reproduces the plantar plate function and brings the toe back into its proper position.

Why choose University Foot and Ankle Institute for Hammer Toe and Plantar Plate Tear treatment?

Whether your curved toe is a hammertoe or the result of a plantar plate tear, the podiatrists of UFAI will use the most advanced technology to provide the most accurate diagnosis and the most effective remedy.

If you’re experiencing foot pain or problems with your feet or ankles, we’re here to help. Our nationally recognized foot and ankle surgeons offer the most advanced care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.

For more information or to schedule a consultation, please call (877) 736-6001 or make an appointment online now.

At University Foot and Ankle Institute, we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations. Masks are required in our institutes at all times.

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