Anatomy

  • Metatarsal heads form the ball of the foot. These are the bones we walk on. The toes are attached to the end of these metatarsals. Ligaments form a “sleeve” around all sides of the joint. Ligaments on the bottom of the joint on the ball of the foot help to hold the toe in normal anatomic position and prevent it from hammering.

Pathology

  • Chronic repetitive stress from the metatarsal head pounding on the plantar soft tissues causes the plantar soft tissue, the ligaments, also known as the plantar plate to weaken, become painful and eventually to tear causing dislocation of the toe.

Treatments

  1. Immobilization and Protection
    This is the single most important treatment. You must protect the injury to give it a chance to heal and to lessen the chance of total rupture. A cam walker boot is used in more severe cases for the short term protection and functional foot orthotic devices are used for less severe injury and for long term treatment, to prevent harmful pronation of the foot during walking. Felt aperture padding can be directly applied to the foot to keep the weight off the metatarsal head.

  2. Steroid Injections and Non-Steroidal Medications
    Cortisone shots reduce pain temporarily. They do not heal the injury, and can cause rupture of the ligment. Cortisone shots are harmful and contra-indicated for this condition. Non-Steroidal Anti-Inflammatory Medications do not relieve inflammation in tendons and give a false sense of security which may prevent you from properly protecting the injury.

  3. Physical Therapy
    Can be mildly helpful to relieve symptoms temporarily but is not capable of stimulating healing of an injured tendon lying deep in the foot. Stretching of this structure by the therapist may be counterproductive and prolong the injury healing time.

  4. Heat vs Cold
    Ice is used only to stop bleeding. Although everyone recommends Ice for almost anything that hurts. This is wrong thinking. Use heat to increase the circulation. Increasing circulation washes out toxins and promotes healing. Use wet heat daily and consistently to promote healing.

  5. Shock Wave Therapy
    Pneumatic shock wave therapy will work like gravity does on bone and jump start the healing process. Treatment is given one time per week for six consecutive weeks. Healing usually takes 6-12 weeks. Shock wave is not covered by insurance. We charge $125 per week for 6 weeks.

  6. Cutting Edge Laser MLS Therapy
    Cutting Edge Laser Therapy is a focused therapeutic treatment given 3 to 5 times per week during the healing process. The laser beam shoots right through the skin and soft tissue and increases the circulation directly around the ligaments and bone washing out toxins and improving healing. It is not covered by insurance. We charge $10 per treatment.

  7. Topaz Surgical Repair of the Ligament
    This procedure is performed in the operating room. No incision is needed for this procedure. Through multiple puncture holes in the bottom of the foot over the ligament, burn holes are created in the ligament with the Topaz wand. The burn holes allow ingrowth of blood vessels into the ligament. Using a needle inserted into your heel bone, bone marrow containing stem cells is extracted and injected directly into the burn holes. It is believed the stem cells further encourage tendon healing and improve the outcome of the operation. The procedure temporarily weakens the ligament but eventually stimulates it to heal. Post operatively a cam walker boot must be worn for six weeks to give the ligament time to heal. All surgery carries risks and possible complications that will be discussed during surgical planning.

Recommendations
Combination therapy always works better. Each part contributes to healing in different ways.

  1. Immobilize and protect with orthotics in some cases cam walker boot.
  2. Stimulate healing with shockwave therapy.
  3. Increase circulation to the tendon with Cutting Edge Laser Therapy 3 times per week.

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