Today on the Doc On Run Podcast we’re talking about 3 different torn plantar plate injury treatment options worth considering.
A torn plantar plate can be one of the most frustrating injuries for a runner.
A runner who has been following many of the suggestions regarding ways to reduce the stress and strain on the plantar plate ligament, has been treating the injury on her own and was getting better.
Then she recently got a set-back and understandably got super frustrated.
But like most strong runners, she is focusing on the possible solutions instead of wallowing in self pity.
She wrote in and said…
I have had a bilateral plantar plate strains/tear (left worse than right) following months of skipping which progressed to single leg skipping causing a plantar plate strain.That was back in January this year. After which I wore a surgical boot on my left foot for six weeks.
During that time I began similar but less severe plantar plate pain in my right foot. I progressed to wearing Hoka running shoes which allowed me to walk almost normally at first. I stayed away from the gym for many months. A few weeks ago I accessed your recommendations for plantar plate healing and implemented them. Over the past few weeks I had attended cycle classes and the occasional step class with modifications ( no lunging jumping etc).
Feeling better this week I attended a cycle class on Monday and step class on Tuesday instead of having a rest day in between classes, and have ended up with 2 painful burning feet under the toes.
This is very depressing !
I am wondering whether it is worth trying the following :
2. Ultrasound therapy
3. Plasma Therapy
I look forward to your thoughts on this as I am desperate to be able to even walk barefoot without pain, to be able to run on the treadmill and jump !!
First of all, Alison thank you for sharing your story and for sending in your question. There are very few things more demoralizing than realizing you have lost some ground in your recovery.
So first and foremost you have to understand that even if you do get a flareup of the plantar plate sprain it’s very rare you actually get so much damage to the ligament that it puts you back to the state of injury you had on day one.
Healing is a continual process. You cannot forget that. Don’t give up hope just yet!
All of the basic self treatments that I teach to runners are in the Plantar Plate Sprain Course for runners. But those are really all things you can do yourself. There are many other treatments that are not even discussed in the course but can also help speed up plantar plate ligament healing. But most require the help of a medical professional.
So let’s talk about each of the three different treatment options you have asked about and are currently considering.
1. Massage Therapy
Massage therapy is an excellent way to promote healing for runners. In fact, I am such a fan of massage therapy for runners that a couple of years ago I recorded an entire podcast interview and episode about massage therapy.
That episode will help you understand how runners and triathletes can use massage as a tool to simply run more, train more, train harder, workout more, build fitness with a lower risk of injury.
Massage therapy isn’t just a way to speed your recovery after a hard workouts. And if you really think about it, any over-training injury is really just an overblown version of the same kind of tissue damage you get as a consequence of training.
One way massage therapy will help you heal faster is that it will help mobilize and remove some of the chronic inflammatory fluid which can actually slowdown the ligament repair process.
A massage session with a highly qualified sports massage therapist will actually serve to push all of those metabolic waste products and degradative enzymes out of your foot and back into your lymphatic system to be drained and removed.
Another way massage therapy will help you heal from a running injury is that it can actually loosen up tight muscle groups and tendons that are increasing the force applied through your foot when you walk. Just think about your foot as a lever on the end of your leg. The stiffer that lever, the more force going through the forefoot, and the plantar plate ligament whenever you walk and push-off.
Just by getting a massage and loosening up all those tight soft tissues in the back of your legs, you can potentially decrease some of the forces going through the plantar plate area.
As I have said over and over, one of the most important aspects of healing a plantar plate injury is to decrease the stress and strain applied through the plantar plate ligament while you are healing.
So, check out episode #63 and then find a qualified massage therapist to help you.
2. Ultrasound Therapy
Ultrasound therapy is not something you can do yourself at home, but you can certainly do it if you see a physical therapist. Ultrasound therapy can stimulate healing in a number of different ways, but probably most importantly because it increases localized blood flow in tissues that don’t normally have great perfusion.
The plantar plate ligament is mostly made up of collagen. It’s very dense tissue. And because it is so dense it doesn’t have a lot of room for blood vessels running through it. Anything you can do to increase the blood flow in and around the plantar plate ligament has the potential to increase the speed of healing.
You have to see a licensed healthcare professional like a physical therapist to get ultrasound therapy. You also have to have a prescription specifically for ultrasound therapy as a component of physical therapy. So if you are going to physical therapy, make sure your doctor specifies ultrasound therapy as one of the treatment modalities the physical therapist can use to help heal your plantar plate sprain.
3. Plasma Therapy
“Plasma therapy,” if I understand your question correctly is probably referring to “platelet rich plasma” or PRP injection therapy.
I started working with platelet rich plasma or PRP therapy almost 20 years ago. Back then the treatment was very new. I actually started a clinical trial at a University Hospital to see whether or not platelet rich plasma could heal soft tissue injuries and whether or not platelet rich plasma had the potential to speed up surgically induced fracture healing.
To get approval to do a clinical trial like that on human beings takes a lot of work. So I basically had to read pretty much everything that had ever been published on the subject and then write a research proposal outlining all of the protocols to see if we could get Institutional Review Board approval to conduct the study.
I feel really fortunate to have been involved in that project because it gave me such a deep understanding of how PRP can help tissues heal.
Although there is a great deal of conflicting research regarding platelet rich plasma, there is a growing consensus about its effectiveness in tendon and ligament injury recovery.
Virtually every time I lecture a medical conference about tendon and ligament injuries in athletes I discuss platelet rich plasma treatments. I also always ask doctors in the audience to raise their hands if they do PRP injections for injuries like plantar plate sprains.
There’s no question that the number of hands going up in the audience at medical conferences when I ask them about who is using PRP injections for plantar plate sprains is definitely on the rise.
So I have done other podcast episodes discussing PRP injections and so won’t going to great detail here about how it works exactly. But in short, all of the co-factors for healing you really need to set about the process of healing an injured tissue are contained within the platelets. When you separate the platelets from your blood and then inject those platelets directly into a tissue is basically like turning a key to unlock the healing process in that tissue.
But it’s not magical! It still has to heal.
I have a very high success rate with PRP injections. But that’s not because I have a magical machine or some kind of Midas touch.
The main reason I see success with PRP injections is because I work primarily with young, healthy, athletic patients who are motivated and physiologically primed to heal. I do not work with old, unhealthy, sick patients. The patients I see, people like you listening to this podcast right now, are simply much healthier, and physiologically far more capable of healing in the general population.
Another reason I have a high success rate with PRP injections is that I treat patients very aggressively in terms of strict non-weightbearing and immobilization in a fracture walking boot for a short period of time following the injection.
Just today, I saw an advertisement on social media regarding PRP injections which claimed “zero downtime.” In that sense it sounds a bit like magical fairy-dust that can stimulate healing even if you decide to go for a jog that day. But trust me, it doesn’t work that way.
Many of the doctors I call on who are in the audience at these medical conferences are also there lecturing. They are also experts who have been invited to the conference to speak and teach other doctors. Almost all the time that I call on these doctors for a question about PRP injections and plantar plates sprains, those doctors will say that the PRP injection is the last thing they will try…before they will consider surgery.
So what that really means to you, is if you’re going to have a PRP injection, if you’re going to be willing to spend the money, and re-injure the plantar plate with the injection, you really want to make sure that you have the best chances of success.
That means you should take time off of work. You should plan to use crutches. You should plan to use a fracture walking boot. Give it a few days to really and truly start to recover in earnest.
Not everyone needs a PRP injection. But if you feel like your recovery is stagnating you have to add something to get your healing back on track
As long as you can find the right treatment for you, at your stage of healing you’ll get back to running as quickly as possible.
One simple step you can take is start with the Healing Runner’s Goal Worksheet.
It will help you take what you know about goal setting in running and use what you already know to focus your healing. It’s free.
Go get it now!
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!