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Re: possible plantar plate tear [VA guy] [ In reply to ]
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VA Guy, I've been dealing with big toe joint pain in my right foot for about 18 months now. Got an X ray a few months back and was diagnosed with Hallux Limitus (partial arthritic joint). I've been able to manage it with Hokas (which have a rockered sole that limits bending of the big toe) and one of these inserted into my right shoe, which you can't even feel:

http://indianabrace.com/turftoe.aspx


Sometimes the joint still hurts after really long runs (15 miles plus), but again, it's manageable, at least for now. Good luck!

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My business-eBodyboarding.com
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Re: possible plantar plate tear [TriBodyboarder] [ In reply to ]
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thanks TriBodyboarder. i did my first run in a month with the carbon plate inserted into my right foot. i find the carbon plate is really too hard and hurts the ball of my foot. what is the indian brace made of? is it hard or soft? did you buy the "pro" model? i have an appt. to be fitted for orthotics but i would prefer not to spend hundreds of dollars if there is something i could rig up myself or buy cheaper. who even knows if expensive orthotics will do the trick???

it is encouraging that you can still run with your arthritis. i have been resting for a month but that didn't seem to help much.
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Re: possible plantar plate tear [VA guy] [ In reply to ]
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I have the runner model. It is VERY thin, like maybe 1mm thick and has a little flex throughout, but is stiff where the big toe goes and that depression in the big toe area plantar-flexes the toe so it's not bending so much at toe off, and when combined with the rocker sole on the Hoka, works well. If you want stiffer, go with the Pro model. With the standard insole that comes with the Hoka, I can't even tell the difference in feel between the right and left feet.

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My business-eBodyboarding.com
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Re: possible plantar plate tear [rroof] [ In reply to ]
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Just curious if these might be plantar plate tear symptoms:

- Soreness under 2nd metatarsal head
- Sharp/shooting pain in 2nd toe
- Pain on push off when running
- 2nd toe bending towards 3rd toe (early stages of hammertoe)
- Pain under 2nd metatarsal head (feels like no padding under the bone) sending shooting pain through 2nd toe when walking barefoot on hard surface
- No pain cycling or skiing, some pain pushing off the wall swimming at times.

X-Ray was clear other than slight hallux valgus and hammertoe. No MRI yet. I'm seeing my orthopedic foot and ankle doc next week. I'm frustrated with this new foot pain since I was feeling back to normal after tarsal tunnel surgery last Feb. I'm wondering if some muscle/gait imbalances caused this latest foot issue.
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Re: possible plantar plate tear [little red] [ In reply to ]
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Yes, they certainly do. But, there are a few other possibilities in your differential diagnosis as well.

X-ray will not show a plantar plate injury, though some clues can be gleaned from it and you have a couple (pre existing hallux valgus, slight drift of the 2nd toe, etc.)

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: possible plantar plate tear [rroof] [ In reply to ]
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That's what I'm afraid of and I appreciate your insight. I guess I'll find out more next week when I see the doc. This has not been a good couple years for me and feet injuries but I guess based on this thread I'm not alone with my current injury.
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Re: possible plantar plate tear [TriBodyboarder] [ In reply to ]
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Take my advice FWIW as I don't know this insert and the magnitude/details of your issue, but I do know these problems quite well in avid runners. Off loading (cut-outs, pockets, shelves...), be it the for the 1st ray relief or for lesser mets (metatarsalgia, capsulitis, plantar plate tears...) can be a slippery slope in runners. They usually provide symptom relief (often immediately) but just know that load isn't going away it is just going somewhere else, so be sure the somewhere else areas are up for the challenge over time.

Reducing dorsiflexion and distributing load is less of a trade-off.

YMMV...literally:)

Happy New Year ST'ers!
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Re: possible plantar plate tear [ktm520] [ In reply to ]
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Appreciate the comments. I did see immediate relief with the X1 plate when I got it last May, and so far, no ill effects to the other toes, which of course are now bearing much of the load. I realize this is a temporary fix though and I'm just trying to stave off the inevitable.

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My business-eBodyboarding.com
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Re: possible plantar plate tear [TriBodyboarder] [ In reply to ]
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well things have changed in the last week. i went for a second opinion because i was kind of irked that the foot surgeon did not even look at my MRI sans. all he did was read the radiology report. i was fitted for orthotics but have not gotten them yet. i have continued to run. there is pain but not enough for me to stop running. the new doctor and his fellow looked at my MRI and took another foot X-ray. He said that my arthritis was not bad but as he scrolled through the MRI scans, he saw something and he said it was an OCD lesion, a small hole in the bone. i was super surprised and was taken aback at this new diagnosis. i barely was able to hear what he said to me following this. so i really do not know what to do. i plan on calling him tomorrow and hoping that he will call me back so i can ask him questions that i wasn't able to ask at the appoint.

dr. roof may you could shed some light on OCD lesions? i googled and learned most of them are in the ankle. will conservative treatment (in a boot) work or does it pay to just go ahead with surgery? i did hear the second doctor say that surgery would entail micro fracture. do these lesions heal? do they move? what if i continue run? what are the ramifications? i am wondering if i should run until i really hurt and really need surgery? does that make the lesion worse, bigger?
i am so confused and am hoping dr. roof you could help. i do plan on calling the doc tomorrow. should i even talk the first doc?

thanks, still in shock by this new diagnosis.
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Re: possible plantar plate tear [VA guy] [ In reply to ]
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Is the OCD in the 2nd met head or 1st? Yes, more common in the ankle/knee, but can be anywhere. If so, this chronic overloading of the 2nd MPJ is just a continuation of the chronic 2nd MPJ pain: overloading > capsulitis > plantar plate injury > DJD (OCD) > Frieberg's infraction, etc. More acute overloading leads to a 2nd met stress fracture (very common in runners).

Treatment plan needs to address both your current issues (wherever you are along this timeline) and the future since I assume your plan is to return to running. This needs to be carefully discussed with your physician(s). Osteochondral defects to not "heal" as humans do not have the ability to regenerate articular cartilage. However, with procedures like microfracture or subchondral drilling, you can get replacement by fibrocartilage which can then make the joint asymptomatic.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: possible plantar plate tear [rroof] [ In reply to ]
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t this is the first met. head. there is no plantar plate tear, no ligament tears. doc said not much arthritis either. he did say he saw the bone bruise on the scan.
what do you feel is the success rate of being in a boot and off the foot. if the lesion won't heal itself, what's the point???
would continuing to run make the lesion larger?
i'm trying to put a call into the doc to see if he will answer some of these questions.
thanks a lot dr. roof.
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Re: possible plantar plate tear [VA guy] [ In reply to ]
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That's right, you were a an initial "turf toe" type injury. Plantar plate issues (thread title) common in runners, but usually the 2nd MPJ.

Osteochondral lesions of the 1st met head not that uncommon a finding. They may or may not need any treatment - purely based on symptoms (which I assume you are having) or you wouldn't be seeking treatment/options. Since you state your plain film X-rays are clear of obvious JDD and just the OCD on MRI, definitely something to address with your doc(s).

As for being in the boot until it "heals" it certainly may. The OCD won't resolve, but it may become asymptomatic in time if you can offload the area long enough (CAM boot, stiff carbon sole, etc.) I'd certainly try before surgery, especially microfracture or OATS type procedures since a very long healing process.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: possible plantar plate tear [rroof] [ In reply to ]
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what would be the ramifications of my continuing to run until the pain gets to unbearable with new orthotics and carbon plate, ice, etc
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Re: possible plantar plate tear [VA guy] [ In reply to ]
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VA guy wrote:
what would be the ramifications of my continuing to run until the pain gets to unbearable with new orthotics and carbon plate, ice, etc

Probably nothing really assuming you aren't altering your gait a bunch and causing other issues from running on the lateral side of your foot (i.e. peroneal tendonitis, IT band syndrome, etc.). Since your osteochondral injury was presumably caused from a traumatic even and not advancing arthritis, it won't likely get worse quickly. Surgery always an option down the road anyway if pain limits your desired activity.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: possible plantar plate tear [tkocanda] [ In reply to ]
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Question for you. I had an MRI and the interpretation is a suspected partial tear of the distal plantar plate of the 3rd and 4th MTP. I first noticed my 4th toe on my right foot would mildly "click" over maybe a year and a half (or more) ago. It never really effected me much until the fall of 2018. Last winter, I had off and on issues running (felt like sock bunched up or stone in my foot - typical morton neuroma sign) but biking was perfectly fine. In the spring of 2019, biking started to become annoying in the right foot where this "clicky" thing was happening. My issue kinda progressed all season this year to the point where I can no longer bike longer than 60 minutes (usually 30' in is the point where things start bio-mechanically going downhill. Toes want to curl up and press into my shoe, arch lifts and then get crampy foot/muscles). It seems like I've lost my ankle stability both on the bike and run and this has now caused annoying bio-mechanical issues biking and running.

I guess my question to you is if you had problems cycling or just running? Does anything I just said about biking sound relatable to you?

I'm seeing a sports medicine doctor next week, but reading through this thread has been helpful to at least tell me what I can expect during this troubling time. Sounds like surgery is not the road I want to have to go down, but I am at a point where I feel that might be my only option. Time will tell I guess.
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Re: possible plantar plate tear [rroof] [ In reply to ]
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Andrew,

I have been diagnosed with a "suspected partial tear of the distal plantar plate of the 3rd and 4th MTP". I described a bit of my situation in the post right before this. Do you have any opinions on whether a partial tear can be corrected through treatment or extensive rest or is surgery the only way to fix this? I'm in the Toronto, Canada area. If surgery, do you have any recommendations up in this area for people to visit? I'm meeting with a respected sport medicine doctor next week in my area, so maybe know more then, but just curious on your thoughts.

Thanks,
Luke
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Re: possible plantar plate tear [drluke12] [ In reply to ]
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I've never seen a tear (partial or full) of the 3rd and 4th plantar plates. That would be exceeding rare and I see a lot of these (just repaired one today - a more common, complete 2nd)

You symptoms (and location) are certainly consistent with a classic Morton's neuroma.

True plantar plate tears don't generally heal on their own, though symptoms can be mitigated by a lot of things (though running/cycling is not one of them) :(

Make sure to get a firm diagnosis before intervention (despite your MRI)

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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