Login required to started new threads

Login required to post replies

Prev Next
possible plantar plate tear
Quote | Reply
i tripped and fell while running 3 weeks before marathon in october. jammed or hyperextended big toe. doc took X-rays and diagnosed turf toe. gave me NSAIDS and plate for shoe. didn't run for a week but was able to run the marathon with no pain. the pain went away and continued running; was able to do yoga, weights, etc.
fast forward to last week and the big toe pain came back. went back to doc and he took another set of X-rays and then pressed on the plantar plate and i hit the ceiling. it was excruciating. so doc things i either tore or strained my plantar plate and gave me an rx for MRI. he said that if it was torn then into a cast, if sprained, into a boot.
can i continue to run on this thing? will it make it worse?
what's the prognosis of this injury? kind of ticked as it's not even an overuse injury but a trip and fall!!!
bike or swim?

RRoof - you around for help? thanks alot.
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
Plantar plate tears are not to be messed around with. I hate repairing them! Don't run until you get a good diagnosis.

Having said that, a plantar plate "tear" of the great toe joint is quite rare and much more common of the 2nd MPJ. Sub 1st MPJ pain usually sesamoid related.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Quote Reply
Re: possible plantar plate tear [rroof] [ In reply to ]
Quote | Reply
thanks Dr. Roof. this is first joint from the fall and doc said sesamoids are not involved (from standing X-ray) i guess MRI will show that.
is it common for the pain to go away and being able to run a marathon and then come back? how about biking and swimming?
thank a ton.
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
No, that would not be common if "torn" from the original fall, then to be able to run a marathon, then hurt again.

Swimming certainly fine (just don't push off the wall with that foot). Some easy MTB probably OK, but hold off anything that really loads the forefoot otherwise (running for sure, but even lots of walking, dress shoes, hills, etc.)

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Quote Reply
Re: possible plantar plate tear [rroof] [ In reply to ]
Quote | Reply
Will report back after i get the MRI. Not sure what best case scenario is regarding results - no torn ligament????
thanks Dr. Roof
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
I had a plantar plate tear of the 2nd MPJ about four years ago. Started in late-2011 or early-2012 and plagued me all of 2012. Did the Texas 70.3 and Syracuse 70.3 and then the pain started to be a bit too much so went and saw a doc. Was told rest, ice, NSAIDs, and all that for a period of 4-6 months... and no running. The no running part was interesting because I had IMAZ in November 2012. Yeah, I did IMAZ on zero run training. Saw doc for follow up just before and saw him again in January 2013. The problem persisted. I didn't want surgery to be an option.

In addition to the plantar plate issue (or partly because of it), I was having calf and achilles problems as well. Then I read Dan Empfield's "Mad Calf Disease" article about Hokas and decided to purchase a pair. Hokas solved my problem and have been trouble free ever since. Also much cheaper and less painful than several more orthopedic surgeon visits and/or surgery.

Dr. Roof can correct me if I'm wrong but in some research on the subject the choice of shoes can be a huge factor in plantar plate problems. Some shoes add increased pressure on the forefoot, and this can be a contributing factor to plantar plate problems. So something like Newtons or zero drop shoes or racing flats can cause issues with certain people. Shoes like Hokas with the rocker can take pressure off the forefoot. Not saying to go out and buy a pair of Hokas as some magic elixir but it might help as it did for me.

Favorite Gear: Dimond | Cadex | Desoto Sport | Hoka One One
Last edited by: The GMAN: Dec 8, 15 5:17
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
I had the great experience of tearing my plantar during college. I could not walk on it without crying and ended up being out in a boot for about 8 weeks then back to doing walk-jog to get back into the swing of things. Definitely go for the MRI because as many have said before this is something that you need to figure out and address. Good Luck.
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
I had a partial tear in my 3rd met in late March, which I believe was caused from stepping on a stone during a trail run about 4 weeks out from a marathon. Bailed at mile 15 on race day, once I realized my goal time wasn't gonna happen. The pain wasn't excruciating like many others experience, but I could feel it with every step, and when I pulled the toe upwards it was definitely a noticeable pain.

I didn't run a step from May until October, but I did ride all summer without any pain, and did some swimming as well (no flip turns as Doc Roof says). It took 3 months before I stopped feeling it on every footstep, although this was probably because I didn't wear a cast or boot (since I wasn't in a ton of pain, my doc and I decided to be conservative with treatment). During that time I got rid of my old running shoes, and I messed with metatarsal pads but didn't find they really did much for my pain. I did tape it every day for about 6 weeks (get the flexible tape that moves a little....Tensoplast is what I used). I started running about 8 weeks ago, and no issues so far. Hopefully it's gone, but I'll be playing it safe as I ramp up train speed and distance.

This was the first "real" running injury I've had in almost 10 years that I couldn't run through, and it was definitely a struggle to get it diagnosed properly. It was also difficult to remain optimistic about eventually returning to running, but if you live in the northern hemisphere, this is the offseason so you have time to let it heal properly before building for the spring. Listen to your doc and follow the rehab protocol. Probably the best advice I've heard in regards to this injury is "wait until you have no pain...and then add 4 weeks before you start running again." Best of luck!
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
I would get the MRI
Quote Reply
Re: possible plantar plate tear [winchester] [ In reply to ]
Quote | Reply
I tore the plantar plate on 2nd mpj and ran on it for 5 years using modified orthodics. I had to have 2 surgeries to get everything fixed. It's all fine now, but I wish I would have gotten everything done sooner. Get the MRI and figure out next steps
Quote Reply
Re: possible plantar plate tear [tkocanda] [ In reply to ]
Quote | Reply
Absolutely going to get the MRI; scheduled it for Friday. I am hoping that it is just tendonitis as opposed to tear or sprain.
The thing that blows my mind is that after the original trip and fall, the pain went away and was able to run the marathon pain free and the pain came back a week ago. Makes no sense to me. Guess it doesn't matter now.

I did do a computrainer class this morning. Not sure if that is too much forefoot pressure.

Dr. Roof, i have a boot at home (from previous achilles issue), should i wear it?

thanks everyone for their replies
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
Won't hurt to wear it for a few days until you get more info from your MRI if you happen to have one. A bit of "forced rest" always good

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
hope to hear back on your MRI report.
Quote Reply
Re: possible plantar plate tear [winchester] [ In reply to ]
Quote | Reply
got the MRI report back:



my impression is that it's a bone bruise. no tears and sprains. some degenerative stuff; probably usual for 60 year old. Dr. Roof - what do you think? good news or bad? don't see doc for a few more weeks. been wearing the boot and not running. (BTW neuroma thing is a surprise as i have no symptoms).
thanks. appreciate any thoughts.
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
sorry if you can't open the report. Here it is:
"there is a moderate diffuse bone marrow edema in the first metatarsal head, out of proportion to mild to moderate overlying cartilage loss, concerning for moderate bone bruise. no evidence of significant sprain or tear in the plantar plate and sesamoid-phalangeal ligaments. Moderate degeneration is noted in the collateral ligaments of the first metatarophalangeal joint. Mild joint effusion and synovitis in the first metatarsopalangeal joint. The visualized extensor and flexor tendons are intact. there is a 7x4 mm morton's neuroma in the third plantar interdigital webspace. the intrinsic musculature is intact.
IMPRESSION:
1. Moderate bone bruise in the first metatarsal head and neck.
2. Mild to moderate cartilage loss with small dorsal spur in the first metatarsal head. Mild joint effusion and synovitis in the first metatarsophalangeal joint. No evidence of significant tear or strain in the plantar plate or sesamoid-phalangeal ligaments.
3. Third interdigital webspace Morton's neuroma".
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
VA guy wrote:
got the MRI report back:



my impression is that it's a bone bruise. no tears and sprains. some degenerative stuff; probably usual for 60 year old. Dr. Roof - what do you think? good news or bad? don't see doc for a few more weeks. been wearing the boot and not running. (BTW neuroma thing is a surprise as i have no symptoms).
thanks. appreciate any thoughts.

Need to correlate MRI findings with clinical symptoms/findings. It appears your MRI findings should have also shown on plain film X-ray though (your great toe joint arthritis for example). Don't worry about the incidental finding of the "neuroma". Radiologist just reading what he/she sees.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Quote Reply
Re: possible plantar plate tear [rroof] [ In reply to ]
Quote | Reply
thanks Dr. Roof. to the best of my knowledge, the X-ray was not remarkable for anything. the doctor never mentioned anything remarkable. i see him 12/28.
in the interim, should i try running/biking? it feels better as i have been in boot and haven't tested it.

thanks.
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
VA guy wrote:
thanks Dr. Roof. to the best of my knowledge, the X-ray was not remarkable for anything. the doctor never mentioned anything remarkable. i see him 12/28.
in the interim, should i try running/biking? it feels better as i have been in boot and haven't tested it.

thanks.

That is why it feels better ;-)

Do whatever your hands on treating physician said you can do at this point. Not sure why you aren't seeing him sooner after your MRI (probably busy around the holidays - I sure am, or time off, etc.) No one has all the pieces though but him

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Quote Reply
Re: possible plantar plate tear [rroof] [ In reply to ]
Quote | Reply
ha. no openings until then. i know ridiculous. any way, after some sleuthing on google i read that a bone bruise is not what we think it is; it is actually a fracturing of the inner layer of bone. that doesn't sound so good to me!! not quite a stress fracture nonetheless something i guess i have to wear a boot for. not happy especially since this was a trip and fall. so i stay in boot until at least 12/28. i might try some swimming w/o pushing off the wall. not sure about computrainer.

thanks for your help dr. roof. i was kind of happy when i first read "bone bruise". bah hum bug.
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
Saw doc today Dr. Roof. He didn't seem concerned about the bone bruise and mostly concerned with the cartilage loss. he said it was arthritis, bone on bone. He said i should wear the carbon plate he gave me (found it uncomfortable so didn't wear it), get orthotics that keeps the big toe from flexing and to buy more rigid sneakers. i have been wearing adidas supernovas which are very flexible.

he didn't seem too alarmed that my running career was over. he also said he could give me a topical arthritis cream to put on the big toe. I seem much more scared than him. Arthritis is a running career killer, no? I think bone on bone and i can't imagine being able to run pain free again. I have not run in three weeks but have done computrainer classes. The biking seems to flare it up (pedal is right in ball of foot).

Dr. Roof - could you please give me your opinions. my MRI report is in a post from a week ago.
Thanks a lot.
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
My 2 cents; I am sure rroof will chime in with sage advice as well.

Use the carbon insoles in everyday shoes; a good orthotist could put an overlay on them to create better contact and they will be much more comfortable. Alternatively, if it is just the first ray than an rigid extension for just the big toe could be deployed in another orthotic.

Rigid running shoes will be helpful; minimalist will be a challenge; Saucony Mirage is the level of flexibility you are looking to match...more drop won't hurt either. Wide toe box with custom or good OTC orthoses (modified) will the goal of moving fulcrum for toe break backwards and reducing MTP dorsiflexion.

Avoid inclines until the symptoms are down; and get a get gait analysis to assess pattern as you may want to consider slowly modifying strike/push-off pattern to reduce forefoot load. Ex: a more hip driven push-off with a midfoot strike. I usually don't screw around too much with pattern; unless it can be associated with an injury or prevention.

For the orthotic, you need to see a specialist as an assessment of your entire foot and the rest of the chain needs to be considered to make the right solution.

P.S. Get cleat extenders (move cleat backwards) for your bike shoes to offload forefoot.

Cheers!
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
As I mentioned before, your "final" diagnosis appears to be arthritis of the 1st MPJ (hallux rigidus) but that should have been diagnosed on your initial X-ray. MRI was not that helpful.

I don't think your running career is over, but you are likely going to accelerate your DJD with certain activities. The stiff carbon plate was a good idea to try if tolerated (my experience is roughly 50/50 tolerate it). Might want to at least use it day to day and then just run in a stiffer shoe. Avoid very flexible forefoot or current fad type shoes. The topical stuff also a good idea to try, but not likely to be all that helpful. There are surgical options to consider if you really can't run.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Quote Reply
Re: possible plantar plate tear [rroof] [ In reply to ]
Quote | Reply
Still digesting what the doc said on Monday. As i said previously Dr. Roof, the doc didn't say anything about the X-ray that he took. Mostly he spoke about the arthritis after reading the MRI impressions. He tested my toe by moving the bones - it hurt - and he said that was because it is bone on bone.
I put the carbon plate in my Hokas and will discuss orthotics next with week with his orthotist. I did try to run on the soft treadmill at the gym and i guess this is what i have to get used to. I hope that when i get orthotics and try some more rigid shoes and get used to the carbon plate and with some time, the symptoms will ease somewhat if that is a possibility. at this point time, i do not want to consider surgery. i am 62 years old and don't want to tackle that just yet.

do you think the hokas are good for first MTJ pain? are there other rigid shoes (rockers) that you recommend?
gonna try a walk run tomorrow morning and asses.
thanks so much. arthritis is a scary diagnosis to me.
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
Hokas are fine. No need for a stiff shoe if you are going to use the plate (that is what it is for).

I've had some runners actually like Newtons because the plantar lugs actually help the foot "come over" the 1st MPJ that you want to limit motion. You may consider trying them if you want to continue to run. If running on a treadmill, avoid high inclines and "sprint" intervals.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Quote Reply
Re: possible plantar plate tear [VA guy] [ In reply to ]
Quote | Reply
Not to hijack your thread but I also recently learned that I have a 2nd MTP plantar plate tear - it occurred on Nov 1. I took a month off running and recently started running again in Altra's and in the Hoka Huaka. Its still sore but improving. I injured it while running in the Nike Vomero 10. I loved this shoe but in retrospect it has an extremely aggressive toe spring which I believe contributed to the injury.
Quote Reply

Prev Next