Today on the Doc on the Run podcast, we’re talking about when a plantar plate tear can cause or contribute to the development of a thing called crossover toe deformity.
If you are a runner and you got diagnosed with a plantar plate sprain, I know you are in for a frustrating course and you probably already figured that out or you would not be watching this video. The plantar plate ligament, it is on the bottom of the foot, right down here at the base of the second toe and it helps hold the toe down against the ground.
So, what is crossover toe deformity? Well, if you look at the foot from the top, typically crossover toe deformity means the big toe tilts this way and the second toe forms a hammer toe and tilts that way and goes over the big toe. And so, when you have the second toe over the big toe, it causes lots of problems.
Number one, it sticks up, right? You can probably see that second toe is sticking up and it rubs in the shoe, causes a painful sore and callus on top of the second toe and it puts pressure on the big toe. So, there are a couple of reasons that you can get this and we’re going to talk about those today.
The first thing is that in order for the hammer toe to develop, you have to have ligamentous laxity or some weakness in the plantar plate that allows the toe to drift up, which is what starts a hammer toe. The reason it goes sideways and drifts over the big toe, well, that’s what we call doctors call medial displacement, like toward the middle of the second toe is typically because the portion of the plantar plate ligament on the outside or lateral side of the plantar plate ligament, it is torn on the outside.
In addition to that, if you have a bunion deformity, that also makes it worse and that also is part of what leads to this problem is that the weight’s not really happening, getting taken up by the bottom of the first metatarsal phalangeal joint. When you get bunions, you have instability that causes the bunion. And so that pressure gets shifted over this direction, right to the second plantar plate ligament, which is what leads to all that irritation.
When you get contracture of the medial collateral ligaments, because it is been sitting twisted over and the little ligaments on the side, medial side called collateral ligaments, when they get tight, because it is been sitting in that position that pulls it over even more. So, if you have tightness over here, weakness or rupture over there, and those two collateral ligaments are in a discrepancy, it helps let the toe drift over.
There’s a study that was published in the Foot and Ankle International. It is the medical journal for the foot and ankle orthopedists in the world and it was published in about 2000. There’s a paper called the medial crossover toe, a cadaveric dissection. What they did was they took a cadaver, that’s right, a dead person who had medial crossover toe deformity, where the second toe was drifting medially over the big toe.
They dissected it down and looked at what was wrong, like what it looks like. And that study discusses it in great detail. So, I’ll put a link to that, the reference at least in the show notes at DocOnTheRun.com under this specific episode. But if you think you have a plantar plate ligament, you do not want your foot to look like this. You want to make sure that you treat it appropriately and you want to make sure that you understand the strategies that you as a runner need to follow if you really want this to get better so you can get back to running.
It is the same strategies that I teach to physicians at medical conferences when I lecture on running injuries. If you want to find out those strategies, I share them for you for free. It is in the Plantar Plate Masterclass. You can get it at www.docontherun.com/plantarplatemasterclass. So, come sign up and I’ll see you in the training.
Reference:
Deland JT, Sung IH. The medial crosssover toe: A cadaveric dissection. Foot Ankle Int. 2000;21(5):375–8.
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