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?
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.
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.
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.)
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.
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.
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!
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
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?
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.
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:
Moderate bone bruise in the first metatarsal head and neck.
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.
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.
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 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
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.
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.
