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Plantar Plate Tear Surgery
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Hi, I'm new to this forum. I was diagnosed with a partial plantar plate tear under 2nd mpj 9 months ago. I am considering surgery-but am wondering if people have had this injury and how they managed it. I'm looking at an osteotomy as my surgery option. Looking to get another opinion-any recs for a dr in PA/NJ? I am hoping to be recovered by July/August. Never thought it would drag out this long! Thanks
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Re: Plantar Plate Tear Surgery [chase02] [ In reply to ]
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These are pretty slow healers, especially you have an actual plantar plate repair in addition to your displacement osteotomy. There was a thread about a year back with someone undergoing and showing timeline very well if you search. He might see this and post his experience as well. Best of luck to you!

There is a nice, newer system called the "Scorpion" that I've used to make things easier - might want to ask your surgeon about it. Here is a short video to scare you ;-)

http://www.youtube.com/watch?v=J-1piyd8Tno

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Plantar Plate Tear Surgery [rroof] [ In reply to ]
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rroof wrote:
These are pretty slow healers, especially you have an actual plantar plate repair in addition to your displacement osteotomy. There was a thread about a year back with someone undergoing and showing timeline very well if you search. He might see this and post his experience as well. Best of luck to you!

There is a nice, newer system called the "Scorpion" that I've used to make things easier - might want to ask your surgeon about it. Here is a short video to scare you ;-)

http://www.youtube.com/watch?v=J-1piyd8Tno

EWWWWWW!!!!

What I do: http://app.strava.com/athletes/345699
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Re: Plantar Plate Tear Surgery [Printer86] [ In reply to ]
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Holy Freaking Smokes !!!

I have always thought it would take a lot to have someone operate on my foot. NOW I AM SURE.
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Re: Plantar Plate Tear Surgery [70Miles] [ In reply to ]
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Soooooooo glad I didn't click that link. :)

It's pretty cool that you help out and answer questions here though rroof. Good stuff.
Last edited by: matto: Mar 6, 12 21:28
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Re: Plantar Plate Tear Surgery [chase02] [ In reply to ]
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Hey, did your plantar plate ever heal? Did you have surgery? Were your toes displaced at all, or just an MRI was used to diagnose the tear?

I've been diagnosed with predislocation syndrome and have been reading up a ton on plantar plate healing. I'm curious as to how yours turned out. My podiatrist is taping down my toes to allow it to heal, but I'm just wondering what kind of timeline I should expect. Did you go to PT for it?

Thanks!!
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Re: Plantar Plate Tear Surgery [rroof] [ In reply to ]
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Hey!

I've seen a ton of your posts on here and was wondering if I could pick your brain for a sec. I have pain in my forefoot that radiates to my toes. Second metatarsal head. 1st podiatrist said it was capsulitis, 2nd podiatrist said it's predislocation syndrome (which is apparently super similar, or the same thing depending on who you talk to). He had me tape my second toes down and walk around and it does alleviate the pain some. He said if it hasn't improved in a week then it's a neuroma--just in a less common place and I'd need an injection.

I'd really rather not have the injection, but at this point I just want it gone. When I plantar flex my toes you can see that the second metatarsal head is slightly more raised than on my other foot. Isn't it possible that the predislocation syndrome is causing the neuroma symptoms? Neuroma symptoms are most annoying first thing in the morning.

So, I guess I just want to know what I should expect. Should I wear a boot? Would that expedite healing? How long can I expect this injury to take to heal? It's clearly a problem with my plantar plate. I've had x-rays--no MRI. Is an injured plantar plate always mean predislocation syndrome?

Sorry for the myriad of questions. I just real dissatisfied with my progress thus far. I have another appointment Wed and am hoping to start PT to help with ultrasound therapy if possible.

Thank you!!
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Re: Plantar Plate Tear Surgery [Kay] [ In reply to ]
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The difference between capsulitis and pre-dislocation syndrome (a term coined by Dr. G. Yu, RIP) is really one of acute vs. chronic. Acute capsulitis usually resolves quickly (say, 6 weeks or less, usually much less). Pre-dislocation syndrome generally starts as capsulitis, but continues because of abnormal biomechanical forces. You may or may not have an actual plantar plate tear/disruption, but you have to have some fault in the plantar plate for the toe to dislocate dorsally on the metatarsal head.

Correcting depends a lot on when treatment begins along this timeline, but in general, pre-dislocation syndrome treatment isn't very successful (esp in athletes). There is no way to predict how long your particular case will take to heal, but plan on WAY longer than you think - then add a few more weeks to that. An x-ray won't show a plantar plate tear (need ultrasound or MRI for that), but if the toe is subluxed/dislocated on X-ray, then by default one can assume and avoid the MRI.

I would avoid the steroid injection unless you were certain this was a 2nd interspace neuroma since it can make the pre-dislocation syndrome worse, although it will likely help your symptoms and I will occasionally employ if a more acute capsulitis. You can have *both* pathologies (neuroma and capsulitis/pds) since the etiology is similar, especially in runners/triathletes, but this would be unusual.

Hope this helps some.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Plantar Plate Tear Surgery [chase02] [ In reply to ]
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I had it....plantar plate tear and an osteotomy. It sucked. Had pins sticking out of 2 toes and in a boot for weeks and weeks. That said, I healed as good as new. Went from dead in the water with pins in my foot to a 70.3 PR 9 months later. I'm good as new. Have a scar and a couple toes that are slightly shorter than the set on the other foot, but i can run, jump etc...just as I used to. I was SUPER worried, but it all worked out.


ADW


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Re: Plantar Plate Tear Surgery [rroof] [ In reply to ]
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Thank you for replying!!!

As of now there's no deformity in my foot. You can't tell there's anything wrong just by looking at it. It's onset was gradual. Sometime in the beginning/mid Jan. After I went to a new yoga class. I've had PTT for months and it's caused me to walk differently. I'm now hoping that PT will help eliminate that. I have a high arch.

When the second podiatrist inspected my foot he moved the toe around and said that if I had capsulitis that him moving my second toe upward would hurt--it didn't. Really the only thing that hurt like CRAZY was when he pushed at the base of my second toe (that's where the plantar plate is, right? Where the toe and forefoot meet?). I feel it when I step on my forefoot--it hurts, but it definitely hurts most in that spot. I know you're not looking at my feet directly, but would you think that I'd need surgery? Why did you say that it doesn't seem to resolve itself in athletes?

I'm hoping that wearing a boot and getting ultrasound therapy on it will allow the tissue to heal--is this an unrealistic hope? Should I request an MRI? Neither podiatrist seems particularly concerned with it, but it's driving me crazy as I haven't seen improvement! I did find relief going to a different physical therapist who used electro therapy something or other on it. When that happened the whole next day I could walk normally. Do I just need to immobilize it to allow it to heal?

Thanks for you help!
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Re: Plantar Plate Tear Surgery [Kay] [ In reply to ]
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Can't really move forward without a more firm diagnosis to differentiate between a plantar plate tear (for which we don't necessarily jump into surgical repair, especially with this injury since surgery is somewhat unpredictable in my opinion) and a 2nd met head stress fracture/reaction/contusion, intermetatarsal neuroma, etc. Not sure what "electro therapy" you had or why this would help, but PT often tends to be just that (trial and error) but if helpful, can't argue with results.

Wearing the CAM boot is certainly helping your PT tendon issue as well. With a high arch foot type, make sure you are good following your PT likely suggestions for posterior gastroc and soleus stretching and progression to inversion/PT strength exercises. If no continued improvement, I'd probably push for an MRI and make sure it is read by a good musculoskeletal radiologist since these plantar plate injuries aren't easy to read/find. The bonus is that you can also get a better look at your PT tendon as well (depending how the exam is done - they usually stop near the ankle since that is *another* exam/bill)

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Plantar Plate Tear Surgery [Onetimepad] [ In reply to ]
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Hi ADW . I am very interested to hear about your surgery.. excellent to hear someone had successful outcome! I desperately need to find a surgeon .. I am an x marathon runner Prior to feet collapse(!!~) and still do triathlons. Running is my passion but painful feet are debilitating.I wear orthotics, have been to 4 foot specialists but none offer me more than 60% chance of success. I also have big toes veering medially! Oh dear~! Please let me know your surgeons details. Many thanks!!!
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Re: Plantar Plate Tear Surgery [rroof] [ In reply to ]
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Hi rroof,

Sadly I am the latest to join the list of posters with plantar plate tears. And I've go them in both feet. I'm a 47 y.o. male, 5'10", 185 lbs. Bike and run a lot and appear to have chronic tears resulting from years of road running mileage. Second metatarsals are longer than the first. Had MRIs on both feet last week. Diagnosis of left foot which is more painful is "a full thickness tear of the lateral attachment of the plantar plate of the second metatarsal phalangeal joint. The central strut and the medial attachment remain in tact. Additionally, there is a thin (partial-thickness) tear of the lateral attachment of the plantar plate of the third metatarsal phalangeal joint. The central strut and the medial attachment appear in tact. Right foot diagnosis is a "full thickness tear of the central strut and a lateral attachment tear of the plantar plate of the second metatarsal phalangeal joint. The medial attachment appears in tact." No evidence of stress fracture in either foot. No evidence of tendinitis or tendon tear in either foot. Mild to moderate hallux valgus deformity in both feet.

Been living with this condition for about four months (to my knowledge) with no real improvement, although I must admit that other than not running I have not curbed my activity much and could do more to encourage healing. Finally went to see a doctor six weeks ago. He gave me orthotics and has been taping down my second toes and more recently sent me for the MRIs. He is now recommending surgery on both feet (repair of plantar plate and shortening of second metatarsals). He says that my second toes are migrating but I swear I can't see it. My feet look the same as always and the second toes are not touching the first or third and don't appear elevated and there is no swelling but there is an almost constant dull ache which doesn't really bother me unless I have to walk a distance. My view is that I want to do as much as I can to give myself a chance to heal without surgery before I chose that option. Seems like there are real mixed results and with two feet at issue I am concerned I won't get a good result in the end. Looking for feedback on whether the degree of injury I have can actually heal itself and tips on what steps I can take to allow that to happen -- regular icing, boot, taping, orthotics, anti-inflammartories, ultrasound, etc. And also suggestions on what I should not be doing -- OK to bike (clipped in with stiff shoes)? Work out on rowing machine? etc. I really don't want to have surgery on my feet if I can avoid it. Any suggestions appreciated. Thanks.

TJT
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Re: Plantar Plate Tear Surgery [TJT] [ In reply to ]
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You appear quite typical - long term runner, hallux valgus deformity (bunion) and long 2nd met (i.e. chronic overloading of the 2nd MTP joint). The bad trifecta.

In my experience, the more complex tears (apparently on your left? and when the toe starts to drift medial - more obvious on X-rays/films before clinically as you said you don't notice it) do NOT heal predictably, even with aggressive immobilization such as casting or CAM boot. Forget taping, orthotics, etc. since most of us on our feet plenty day to day. Also, by "healing" I mean so that you can get back to running (which is what I assume you would be after). They can certainly be largely asymptomatic like a mild rotator cuff tear in the shoulder for daily activities if that is your goal. But your biomechanical issues of the HAV deformity and long 2nd met would always have you predisposed to this chronic issue with most other sporting activities. The orthotics, taping, icing, ultrasound, etc. are for pain in the area prior to the plate tears in my opinion.

As to your question: sure, can bike (little to no dorsiflexion at the MTP joint in cycling shoes), swim, etc. but the above still applies. Also, the only guy who examined you is recommending surgery and that is more important than anything else. Nothing wrong with another opinion and I'd recommend if possible. Since a chronic issue, no hurry.

Best of luck.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Plantar Plate Tear Surgery [rroof] [ In reply to ]
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Thanks for your insights. One final question -- when surgery is called for on both feet, is it better to operate on both at the same time or one at a time. I can see benefits/drawbacks to each.
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Re: Plantar Plate Tear Surgery [TJT] [ In reply to ]
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TJT wrote:
Thanks for your insights. One final question -- when surgery is called for on both feet, is it better to operate on both at the same time or one at a time. I can see benefits/drawbacks to each.

I'd recommend to just do one at a time in most all cases. Something to discuss with your surgeon though of course.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Plantar Plate Tear Surgery [rroof] [ In reply to ]
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Thanks again!
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Re: Plantar Plate Tear Surgery [TJT] [ In reply to ]
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Resurrecting old thread but I’m interested in the outcome with TJT.
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