How can a dancer’s pad lead to a plantar plate sprain? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just got a great question from a runner who had been using a thing called a dancer’s pad. A dancer’s pad is sometimes used to help an injury to these little bones under the big toe joint called the “sesamoid bones.” If one of the sesamoids is painful and irritated and you’re trying to take the pressure off of it, an easy way to do that is to place a dancer’s pad in your shoe.
A dancer’s pad can be made with something simple like this. This is a metatarsal pad. You can see it’s just a little bit dome shaped, it’s kind of teardrop shaped. But if you want to turn it into a dancer’s pad, what we do is we actually take it and we just cut out a little section of it like that. Now what we have is a pad that has a little cutout, but otherwise it can take the pressure off.
If we take this pad and we stick it right on the foot in an area where it’s going to take the pressure away from the sesamoids, if the goal is to remove the pressure from the sesamoids and we put the pad right here. Well, what that does is it shifts all of the pressure off of the sesamoids because it leaves a big depression where the sesamoids kind of sit in the depression in that pad without irritating it so much. So that seems like a great thing. But what you’re doing then is you’re basically robbing from Peter to pay Paul. Nothing’s for free and you can’t alter the laws of physics.
When you take the dancers pad and you put it on the foot to remove all that pressure there, well it puts a whole lot of pressure everywhere else. And your plantar plate ligament for your second toe is sitting right in here. And so what happens is every time you take a step and your heel comes off the ground and you basically start rubbing the plantar plate ligament up against the edge of that dancer’s pad, right at that corner right there, well it starts to irritate it.
Now the goal, of course, of the dancer’s pad is to take the pressure off the sesamoids, put it on the shaft of all these other metatarsals. But you’ve got to remember that that area under the big toe joint, that area is 50% of your weight when you’re walking. And so if you take a pad that removes all of that, I mean, it’s not going to remove all of it. But theoretically, if you removed all that pressure that’s under the sesamoid bones with a dancer’s pad, that’s half your body weight and it has to go somewhere else.
So where does it go? It goes that direction, laterally, toward the second metatarsal, right where the plantar plate is sitting. And so if you take that 50% of pressure away from the big toe joint, it doesn’t just disappear, it just gets moved to the other areas of the foot where the pad is sitting. And a lot of the pressure, as your heel comes off the ground, starts putting more and more pressure right on the plantar plate ligament.
That is how the plantar plate can start to become irritated and inflamed, and in some cases, even develop into a plantar plate ligament sprain or an injury to that little ligament under the base of the toe where it attaches at the metatarsophalangeal joint at the ball of the foot. So if you’ve got a dancer’s pad and you’re starting to get some irritation in there, make sure you think about that and consider whether or not this could be contributing to some of your trouble.