#156 Can I race with a plantar plate sprain? | DOC

#156 Can I race with a plantar plate sprain?

Today on the Doc On the Run Podcast, we’re talking about whether or not you can race with a plantar plate sprain.

If you are running with pain in the ball of the foot that seems like a stress fracture, it could be a plantar plate sprain. If you get a plantar plate sprain right before a race, the obvious question is whether or not you should do the event.

If you have a sprain of the plantar plate ligament, you may still be able to do your race. You just have to decide how bad the injury is, what your long-term goals are, and how badly you want to to participate in the event.

Yesterday I saw a patient, and she was really interesting. She was really fired up about a race she has this weekend, but she just got a sprain or an injury to the plantar plate ligament at the ball of the foot. So, she noticed her foot was hurting, she tried to run, it was bugging her, she knew something was wrong and she wanted to figure out what was going on. She thought it was a stress fracture. 

I took a look at her, and actually, it wasn’t a stress fracture. So first of all, a plantar plate sprain is one of the things that’s often misdiagnosed as a stress fracture, a metatarsal stress fracture in runners. And they can be similar, you have pain in the same area, they kind of feel the same, present the same, you get a little bit of swelling, maybe a little bit of bruising, and it hurts at the ball of the foot at the base of the toes. Well, that’s what she had, was a plantar plate sprain.

So, she wants to do this race this weekend, so her big question of course, is, can I race this weekend? Well, as I’ve said before, you can do anything you want, you just have to be willing to pay the consequences. I know that sounds like I’m trying to be facetious, but that’s the fact, is you have to figure out whether or not you’re willing to pay that price. So what does that mean? Well, first of all you want to make sure that you’re not going to make the injury worse, you don’t want to cause irreparable damage. 

If you really want to keep running for years, and years, and years, and you want to stay healthy and active, and you want to continue to run for many years, you don’t want to make it worse, you don’t want to cause a permanent injury. If you have a bad metatarsal stress fracture, if it’s really cracked all the way through and you run on it you probably will make it significantly worse, because it could completely crack and move out of position, and then we would have to do surgery to put it back in position, and put a little plate and some screws on it. But that’s not necessarily the case when you have a plantar plate sprain.

So, you can get a plantar plate sprain for lots of different reasons, you can get it jumping rope, doing elliptical trainers, you can get it from wearing high heeled shoes at an event, from walking long distances in high heeled shoes. All those things put lots of stress and sprain on the plantar plate, and they can sprain the plantar plate ligament. 

To make it worse you have to basically do the same thing or apply the same sort of deforming force to the plantar plate ligament in order to rip it, tear it, make it worse, whatever it is that can make it irreparable damage where you have to have surgery. So, in her case it was a very minor sprain of the plantar plate. I looked at it, I checked it, I showed her how to check it, I showed her how to tell whether or not it was getting worse, or whether or not it was really bad, and how to assess whether or not it’s getting worse if she’s doing some activity.

But in her case, what I said was, “Look, if you really want to do the race I think you can do it. This is not like a partially torn achilles tendon, or a really bad stress fracture, or a stress fracture in the heel bone, or something like that that could completely explode, and then really damage your future as a runner for the rest of your life as a minor injury. It’s barely injured, it’s irritated, but I think that you could probably do the race if you just figure out how to reduce the inflammation so it doesn’t hurt so much, and take some of the stress and strain off the plantar ligament at the bottom of the plantar plate, at the bottom of second toe joint.”

So, I showed her how to do that, I showed her how to reinforce by taping the toe to take some of the stress off the plantar plate ligament, I showed her how she could do some stuff to reduce the inflammation at home, just in the next couple of days, and I showed her how to take the pressure off the plantar plate ligament by modifying her shoe inserts, and telling her which running shoes she should use, and which ones she should avoid. And then, we modified all of those shoes to take some of the stress off, and then she’s going to race this weekend. 

Now, she’s probably going to feel it once or twice during the event, where she puts in an extra amount of pressure and strain on the plantar plate ligament, but it’s not going to kill her. I don’t really think it’s going to delay her recovery. But you have to really know where you are on this continuum of trouble. Is it a minor plantar plate sprain, or is it a really bad plantar plate sprain? Are you actually at risk of ripping the ligament completely, or is it just going to kind of be annoying and aggravating while you do your race?

Then, if you know what the difference is between how bad it is or how bad it really isn’t, then you can make a decision about whether or not it’s really worth doing your race. But that’s the bottom line, you have to figure out how bad it is, you have to figure out what your timeline is, and you have to figure out what your longterm goals are to decide whether or not you can race with a plantar plate sprain. 

If you have a question that you would like answered as a future edition the Doc On The Run Podcast, send it to me, and then make sure you join me in the next edition of the Doc On The Run Podcast. Thanks again for listening!