Does a mallet toe lead to a plantar plate sprain in runners? Well, that is a good question and that is what we’re talking about today on the Doc On The Run Podcast.
I often get questions about plantar plate injuries in runners, and this is a very common topic at medical conferences and among runners who get pain in the ball of the foot. I just spoke to a runner who had an interesting question, which I never would have imagined, and she wanted to know whether or not a mallet toe might lead to a plantar plate sprain because she didn’t really understand the difference between a mallet toe and a hammer toe and understands that somehow those things might be related to plantar plate injuries.
Part of this comes from a paper that was published in the Journal of the American Podiatric Medical Association by a guy named Dr. Gerard Yu, who was a very well-known podiatrist that contributed a lot to podiatry. He wrote this paper talking about pre-dislocation syndrome, which talks about how the plantar plate gets injured and then leads to a hammer toe.
Let’s talk about how that works real quick. So, when you look at the foot and where you have the toe, you’ve only got a few things in there. You have the first metatarsal bone here. Then you have the proximal phalanx bone here, intermediate phalanx bone and the distal phalanx bone. The plantar plate is down on the bottom of the joint capsule down here under the first metatarsal phalangeal joint.
When you get a plantar plate sprain, it’s because you get a little tear or a split or something, an injury, a sprain to the plantar plate there. Then if you have a mallet toe, it is a contracture at this level. So, you have all these joints. You have the metatarsal phalangeal joint, the proximal interphalangeal joint here, and the distal interphalangeal joint here.
A mallet toe is where the toe gets contracted here and, in that case, the toe starts to look different. It looks like this where you have the first metatarsal bone. You have the proximal phalanx is in the right position. The intermediate phalanx is in the right position. But then this one is in the wrong position. So, it’s contracted here at the distal interphalangeal joint and it’s contracted there.
Now because the bone here and here is in the same position, the plantar plate ligament has no excess strain on it. It’s not more likely to get a plantar plate injury just because you have a mallet toe because it’s a contracture at the end of the toe.
A hammer toe is different. A hammer toe is where the distal interphalangeal joint is not that bad off, but the proximal interphalangeal joint here is where the contracture is happening. So, you have the first metatarsal bone. You have the proximal phalanx bone, the intermediate phalanx, and then the distal phalanx. And so, this one is contracted this direction. This one’s contracted in that direction.
They’re both contracted in different ways and this one though, because this bone lifts up, guess what? That is what leads to that tear in the plantar plate down here. That is where it rips. So, the plantar plate rips when the toe gets pushed up at that joint right there. And that is how that happens. So, if you have a hammer toe, way more likely to contribute to a plantar plate sprain.
If you have a mallet toe or a normal toe, not likely to lead to a plantar plate injury. Completely different, but good question.
If you want to learn more about plantar plate injuries and you’re a runner, you can check out the plantar plate masterclass. You can come join me. I do a deep dive into the strategies I use with runners who have these injuries and want to stay fit, keep working out and get back to running faster. You can get it for free at www.docontherun.com/plantarplatemasterclass. Come check it out and I’ll see you in the training.
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