#567 Can a mallet toe cause a plantar plate injury? - DOC

#567 Can a mallet toe cause a plantar plate injury?

Can a mallet toe cause a plantar plate injury? Well, that’s what we’re talking about today on the Doc On The Run podcast.



This is a great question I got from somebody. This is someone who had a thing called a mallet toe and he wanted to know if this could cause a plantar plate injury because he’d had some pain in the ball of foot. He was reading about plantar plate sprains, and he thought, “Maybe I have a plantar plate sprain because I got this funky toe.”

Let’s talk about what a mallet toe is. So when we look at your foot and the normal position of the toe, you’ve got the metatarsal sitting here. You have the proximal phalanx and the intermediate phalanx and the distal phalanx and then you have the joint capsule, and the plantar plate is a thickening on the bottom of the joint capsule.

A mallet toe is where you have a contracture at what we call the distal interphalangeal joint, or DIPJ for short. But it’s the distal, meaning furthest away from you, and interphalangeal, meaning between these two phalanx bones, and it’s a joint. So that’s why it’s called the distal interphalangeal joint. A mallet toe is a contracture where you have this routine, where the toe is more or less straight, except it is deviated at the distal interphalangeal joint.

So everything else in here is pretty much normal. The position of the proximal phalanx bone, this one is pretty much the same. The position of the intermediate phalanx is often the same, but then it is deviated here and what that does and why that’s important and why it’s relevant to plantar plate injuries is that when you get a plantar plate injury, it’s because you have a hammer toe, not a mallet toe.

A hammer toe is different. A hammer toe is where this bone is deviated here and believe it or not, these are questions that medical students get hammered on in exams. But it’s deviated differently. So in a hammer toe, you often have this bone is more or less in the correct position, but it’s the deviation is at this joint at the proximal interphalangeal joint, which is different. So when it’s deviated at the proximal interphalangeal joint, that’s a hammer toe.

When it’s deviated at the distal interphalangeal joint, that is a mallet toe. Now, when you have that, the important point here is that when you have a hammer toe, it pulls and stresses the plantar plate on the bottom. This does not because the proximal phalanx bone is pretty much in the same attitude. So if you look at the alignment here, these are the same. This one is really deviated, and that’s where you get trouble pulling on the plantar plate on the bottom.

So if you have a mallet toe, yes, it’s crooked, and yes, it can cause a problem and sometimes doctors want to go in and release the tendon at the end of the toe right here to try to fix it. But if you do that, then you’re more likely to get a mallet toe on another toe, believe it or not, because you’re increasing the force on the other toes. That’s probably a whole another episode. But the important thing to realize is that just because you have a mallet toe does not mean you’re going to wind up with a plantar plate sprain. It doesn’t mean that at all. It just means that you have a crooked toe here.

Now you may get some other issues like pain on the end of the toe because you have too much pressure, because of the fat pads down here and then instead of putting pressure on the fat pad, the cushions, you’re getting pressure on the end of the toe and that can cause some soreness and callouses and other things, but not really a plantar plate sprain. So just because you have a mallet toe, you do not necessarily need to be worried that you’re going to get a plantar plate injury.

If you found this useful, please like it, share it, give it to one of your running friends who might have some funky looking toes, if they’re worried about they’ve got pain in the ball of foot and think they have a plantar plate sprain. And if you haven’t checked it out yet, check out the plantar plate masterclasses, where I go into a deep dive, about half an hour specific training for runners who are concerned about plantar plate injuries and teach you everything you need to know about the things you really need to be looking for, watching out for. And you can get it for free at docontherun.com/plantarplatemasterclass. Go check it out and I’ll see you in the training.