In brachymetatarsia, floating toe is most commonly caused by what?

• A. Increased plantar fascia tension
• B. Overstretched Achilles tendon
• C. Tension in extensor digitorum longus
• D. Lack of tension on the plantar fascia

Answer: (D)

Floating toe occurs when a toe fails to contact the ground during weight bearing. In brachymetatarsia, the forefoot balance is disrupted by a shortened metatarsal, and the plantar fascia needs to have adequate tension to tether the toe to the plantar aspect and help the windlass mechanism stabilize the arch. When plantar fascia tension is insufficient, that plantar tether is lost, so the toe sits up and does not press against the ground. The other potential factors would influence different mechanics, but they don’t account for the toe’s loss of ground contact as directly as reduced plantar fascia tension does.