When runners experience pain under the ‘ball’ of their 2nd toe, the most likely cause may be an injury to the plantar plate, otherwise known as pre-dislocation syndrome. This injury can have many names including: plantar plate rupture, floating toe, or crossover toe. Regardless of what it is called, the progression is the same: subluxation or partial dislocation of your toe due to inflammation of the metatarsal-phalangeal joint. This condition can theoretically occur in any of the five metatarsophalangeal joints (MPJ’s), however, the most common location for pre-dislocation syndrome is the 2nd MPJ. Since your 2nd metatarsal bone is the longest in the foot, it will absorb and transmit a majority of the force from the ground while running, resulting in increased wear and tear. Other causes of pre-dislocation syndrome include: trauma, inflammatory diseases, anatomical variants such as an extremely long 2nd metatarsal bone, capsule/ligament stretching, hammertoes, metatarsalgia, and also bunion deformities.
Symptoms:
After running, you may notice increased inflammation, warmth, pain, and swelling under your metatarsophalangeal joint. Upon dorsiflexion, (bringing your toe up to the sky), pain will be exacerbated.
Conservative Treatment:
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Strapping/taping
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Running shoes with an extra wide toe box
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NSAID’s, ice, rest
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Immobilization
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Physical therapy
Steroid injections are typically contraindicated because they can potentially lead to further rupture and damage to your toe ligaments and capsule.
Surgical treatment may be indicated for chronic cases or when conservative methods fail.
Be aware, this condition can be quite debilitating as it progresses, so early diagnosis and intervention is the key to keeping you running pain free. If these symptoms sound familiar, please give us a call at 406-721-4007 so we may help you.