Category Archives: Foot Problems

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.

Cuboid Syndrome

The cuboid is a smaller cube shaped bone on the lateral side of the foot around about the center of the foot. The bone is a little bigger than a common gaming dice. The bone participates in three joints and operates as a lever for the tendon of the peroneus longus muscle to pass under. Since this is a strong muscle it can move the cuboid bone too much if it is not secure and strain those joints that the bone is a part of resulting in a ailment known as cuboid syndrome. This is probably one of the more common causes of pain on the outside of the foot, generally in athletes. The pain commonly begins quite mild and is located around where the cuboid bone is on the outside of the foot. The pain is only at first present during activity. If the exercise levels are not lessened the problem will most likely progress and then show up after exercise in addition to during. From time to time the pain can radiate down into the foot. Although this is the commonest reason for pain in this area, there are others like tendinopathy and nerve impingements.

The main management of cuboid syndrome is relief of pain. This is normally done with a reduction in exercise levels and the using of low dye strapping to immobilise and support the cuboid. Mobilisation and manipulation is frequently used to fix this condition. Over the longer term foot orthoses may be required to control the movement and support the lateral arch of the foot. This helps make the cuboid more stable so it is an efficient lever or pulley for the tendon to function around. Generally this approach works in most cases. If it doesn’t there are no surgical or more advanced treatments and a further reduction in activity amounts is usually the only option.

Chinese Foot Binding

There is a historic technique from rural China which involved the binding of the feet of female children to prevent them from growing. It was a brutal process and was debilitating and disabling to the feet. It was carried out as a smaller sized foot was considered an attractive feature in the female and a higher dowry can be asked for by the family for the bride-to-be when the feet had been bound. There was a considerable market in these rural communities for the ornamental and finely crafted shoes that these girls would need to wear because of the smaller and deformed feet. More than 100 or so years ago cultural pressures began to mount to ban the practice and this generally was successful and it is not done any longer. The practice had to stop as it was so disabling and painful for the child. When they became an adult, the damage had been done and there is not much that could be done to manage the suffering and deformity. Having said that, you will still find many elderly woman still living that had their feet bound when they were little girls.

You will find theoretically parallels to this practice of chinese foot binding that may be seen nowadays. A number of experts try to link the practice these days of females who force their feet into the high heel shoes as being the same as the foot binding. In rural China the practice was all about the female doing something that pleases the male, no matter the outcomes in terms of pain and deformity. The practice today of wearing tight fitting high heel shoes by females has consequences in the terms of foot disability and foot pain. It is also apparently done in the context of the female doing something which is pleasing to the eye of the man. There is some disagreement if the connection between the two practices really do warrant the type of evaluation that they have been put through.