What is a plantar plate tear?

A plantar plate tear is a strain or small tear in the ligament plantar to one or more of the lessor metatarsophalgeal joints in the ball of the foot. It commonly is associated with a bunion or hallux valgus.

The symptoms of a plantar plate tear are typically pain under the ball of the foot when walking that is much more painful on palpation. On palpation, the pain is under and just distal to the joint. It normally starts off slowly, but progressively gets worse, especially if there are high levels of activity.

Often the best way to treat this problem is with taping to hold the toe plantarflexed to relieve the strain on the dysfunction or tear to that it can heal. Usually the taping or some sort of bracing does help, but occasionally surgery is needed to repair the tear. Sometime up to 3-6 months of the taping is needed. A rocker sole shoe can also help keep the load of the damaged area.

Jacks Test

Jacks Test (or the Hubscher maneuver) is a clinical test that is used to test the integrity of motions and forces at the first metatarsophalangeal joint and the windlass mechanism of the foot. The aim of the text is to dorsiflex the hallux while the foot is weightbearing and determine how hard the hallux is to dorsiflex and and easy it is to raise the arch of the foot during the test. This information is often used to guide interventions when there are problems with function of the joint and the integrity of the windlass mechanism at supporting the arch of the foot. It was originally described in the context of surgery for flat foot. There have been questions about the test’s validity, but it is still widely used in clinical practice.

Functional Hallux Limitus

Functional Hallux Limitus is a hypothetical problem that, like bunions, affects the first metatarsophalangeal joint. It is hypothetical as there is some controversy about it. Functional hallux limitus is defined as a condition in when the first metatarsophalangeal joint has a full normal range of motion during non-weightbearing, but during the weightbearing gait the joint just does not seem to want to bend. As a results there are some compensations, such as “overpronation”, elsewhere in the foot that can result in symptoms.

There are a number of different pathomechanical entities that can cause functional hallux limitus. Most of these exert there effect by preventing plantarflexion of the first metatarsophalangeal joint

If it is present then the standard approach to treatment is to use foot orthotic designs that facilitate motion of the joint by allowing plantarflexion of the foot.

Overpronation and Bunions

Like ‘bunions’ there is so much misinformation on the web about this thing called ‘overpronation’. So much nonsense and so many myths are written about it. Unless you are familiar with all the issues, it can be hard to distinguish the good information from the bad information.

If you are on this site, then we assume you know what bunions are! ‘Overpronation’ is the term given to a situation when the ankle joint rolls inwards or medially too much. The problem with the term is that pronation is actually a quite normal motion and there is no consensus what is normal and what is over. This is why so much nonsense gets written on the web about it. Too much of the pronation is generally considered problematic (but not by everyone) and can increase the risk for foot and leg problems. One of those foot problems that it could be associated with is bunions.

What is the link between Overpronation and Bunions?



The potential for a link between the two comes about as there is good evidence that those with bunions or hallux valgus have more flat feet and those with flat feet (or overpronation) are more likely to have bunions or hallux valgus. There is a pretty reasonable theoretical mechanism how a flat or overpronated foot could lead to a bunion or hallux valgus, but that does not mean that the flat feet caused it. It could well be that people develop bunions and due to medial column weakness, the arch collapses. This could be the cause of the overpronation.

So it really is a ‘chicken or egg’ situation. Which came first? The pronation or the bunion (hallux valgus)? Some people think they know, but the don’t. there is no evidence one way or the other as to which one happens first.

Having said that, it is still important the the problem of any overpronation be addressed as pert of the management of bunions and hallux valgus. Clinical experience does support that there are better overall outcomes when it is addressed.