What is a Plantar Plate Tear

A plantar plate tear is a relatively common problem under the ball of the foot. The plantar plate is a strong thicker ligament below the metatarsaophalangeal joints in the ball of the foot. There can be a tear, strain or what often is described as a ‘dysfunction‘ of that ligament that causes pain under the joint and just distal t the joint. One weird sensation that often get describes is that of the feel of a sock bunched up under the toes, when its not.

A plantar plate problem is more common in those who are over weight, who are more active and have foot problems such as bunions.

The treatment of a plantar plate tear is to rest the area by holding the toe plantar flexed with strapping. A rocker sole shoe also stops the toe from bending so much and is often helpful. This “rest” of the strain on the ligament usually helps most cases. In the few that this does not help, then a surgical repair of the small tear is often indicated.

Dealing with Severs Disease

Sever’s disease, or more appropriately called calcaneal apophysitis is an overuse problem with the growth plate at the back of the heel bone in children. It is more common around the ages of 10-12 years and always goes away by the mid-teenage years when growth of the heel bone stops and the cartilage growth plate merges with the rest of the heel bone.

The pain is typically at the back of the heel bone and at the sides, especially on squeezing the heel bone and especially after sports activity. It is more common in those who are more active. On occasion the pain from Severs disease can be so bad as to make the child cry, but there is very little or no swelling visible.

Severs disease is best managed with reducing activity and managing expectations. The child will grow out of it, but as it painful it still needs o be treated. The reduction in activity needs o be negotiated with the child as they will be reluctant. ICE can be used after activity to help with the pain. A cushioned heel raise is often used to protect the area.

Dealing with Chilblains

Chilblains are a common problem of the microcirculation in colder climates.

Chilblains start as an inflammatory response caused by changes in those that are vulnerable. They are seasonal and occur in the colder temperatures. They can be a particular problem in extreme sports. that take place in the cold environments. While they start out as red itchy and painful spots, if they keep recurring they become chronic and take on a dark blue coloration.

The best way to deal with chilblains is to prevent them in the first place. The feet must be kept warm with the use of appropriate socks and shoes. If the foot does become cold, it is important that it is only warmed up slowly and the circulation give time to respond to the warming temperature. It is thought that a keep issue on chilblains is the too rapid warming of the skin after it is cold.

If a chilblain does develop, then the best approach is to keep it warm, stimulate the circulation with gentle massage with creams and to protect the skin from breaking down. If the skin is broken, then wound dressings need to be used to allow it to heal up.

The Term ‘Overpronation’

Overpronation is one of the most overused and misunderstood terms in running and health professional communities, especially when it comes to the use of running shoes. The whole traditional model of the design of different running shoes are based on the concept of the normal or neutral alignment of the foot. Pronation is when the foot rolls inwards at the ankle joint and the arch collapses. Supination is when the foot rolls outwards at the ankle and the arch height increases. These are normal healthy movements that are needed for normal function of the foot. It is how the foot adapts to uneven surfaces and absorbs shock. There is nothing wrong with the motions of pronation or supination.

The term overpronation is used to describe when there is too much pronation. The reason is that this is an issue is that overpronation assumed to be a risk factor for many different running injuries. For this reason, running shoes have design features in them that are supposed to help control this overpronation. These design features include medial heel posts, dual density midsoles and rigid heel counters. These shoes are supposed to be used by those who overpronate. Those who do not overpronate should use cushioned neutral shoes.

The problem with this concept is that the term is overused a lot. There is no consensus as to the cut-off point between normal pronation and overpronation. There is also very little evidence linking overpronation to running injury and if there is any, it is showing that it is only a very small risk factor. Plenty of runners overpronate severely and never have problems. Similarly, there are plenty of runners who do not overpronate that have a lot of problems. Due to this confusion, there has been a recent change in the use of the term and the understanding of overpronation in relationship to running injury and the use of running shoes.