Today on the Doc On The Run podcast, we’re talking about the difference between a plantar plate sprain vs. a tear vs. a rupture when you are a runner.
If you’re a runner who has had aching pain in the ball of the foot you may have been diagnosed with a plantar plate sprain, or a plantar plate tear, or maybe you were told you had a plantar plate rupture. 
The most important factor to a runner is how quickly you can heal the plantar plate and get back to running.
The chances are good your doctor didn’t really discuss this component of your treatment plan.
When you get a plantar plate injury many doctors will simply tell you to stop running and let it heal.
That plan can take months. As I have said many times before, waiting is not a treatment plan.
If you are a runner with a plantar plate injury you need to understand the differences between the terms used to describe the condition so you can better understand what you need to do to heal it and get back to running.
It may help you to understand the differences between the terms doctors use when describing plantar plate injuries.
What is the plantar plate?
The plantar plate is a very small ligament on the bottom of the joint capsule at the base of the toes. When you stand up on the ball of the foot you’re basically stepping right on the plantar plate at each of the toes.
A ligament is just a band of tissue designed to reinforce and stabilize a structure by holding two bones together. The plantar plate ligament is mostly made up of collagen strands.
What is a sprain?
A sprain is an injury to any ligament. That could be the plantar plate or it could be the ligaments that stabilize your ankle.
When you get a ligament sprain, you overstretch the ligament and some of the collagen strands break. Doctors grade ligament sprains as either a Grade 1, Grade 2, or Grade 3.
Grade 1 ligament sprain means there is a a tiny little section or perforations in the ligament. If you look at it it would appear to be intact. But if you stretch it out you might see where there are some tiny little sections where it is been damaged.
If you take a flat rubber band and stretch it out a bunch of times and then pull it tight and hold it up to the light you may see little wavy sections within the rubber band that would indicate little rips on the inside of the rubber band. That would be analogous to a Grade 1 ligament sprain.
Grade 2 ligament sprain means there is a very small section of the ligament that is torn. If you take a flat rubber band and cut the edges it was some scissors, that would be analogous to a grade 2 ligament sprain. In that case, the ligament is still partially intact, it is still mostly connected and is still functioning. It just has a little rip in the side.
Grade 3 ligament sprain means the ligament is completely torn and completely broken. It is no longer in tact and is no longer providing the support to stabilize the joint.
What is a plantar plate sprain?
A plantar plate sprain just means you have some section of the plantar plate segment that has been ripped or torn. However the term “plantar plate sprain” doesn’t really help you decide when you’re going to get back to running.
The grading system doctors used to describe ligament injuries does tell you if it’s partially intact, just barely injured or completely ripped apart.
Unfortunately for runners, you almost never hear a doctor tell you that you have suffered a Grade 1, Grade 2, or Grade 3 plantar plate sprain.
If you think about the term plantar plate rupture and you think about the grading system we just described, when a doctor tells you that you have a plantar plate rupture you probable assume it would be completely ripped. But that is not necessarily the case.
Sometimes, if your doctor actually shares your MRI report with you, your doctor may tell you that it looks like you have a “partial rupture.” Of course, That is different than a complete rupture.
By themselves, the terms “plantar plate sprain,” “plantar plate rupture,” and “plantar plate tear” are basically useless to an injured runner trying to get back to running. The severity of the injury is what’s really important.
A Grade 1 sprain of the plantar plate is not nearly as bad as a Grade 3 sprain of the plantar plate.
A partial rupture of the plantar plate is not nearly as bad as a complete rupture of the plantar plate.
A partial tear of the plantar plate is not nearly as bad as a complete tear of the plantar plate.
The real difficulty for you as a runner is in trying figure out whether or not you have a ligament that is partially torn, completely torn, and how quickly it is going to heal.
In that respect, you have to pin your doctor down and get a real answer. And if you look at your MRI report and your MRI report does not give a clear answer you have to figure it out on your own.
Don’t ever forget, many surgeons are going to try to sell you a trip to the operating room.
If your plantar plate ligament is refusing to heal, and you really have tried all the treatments that can or should get it to heal, then you might need a trip to the operating room. But not all runners should have surgery.
The only case when you absolutely have to have surgery is when your ligament is 100% torn, the joint capsule is compromised and your toe is dislocating. But if you fall in that huge gray area of injury, you can probably get it to heal on your own, if you just understand how to decrease the stress and strain to the plantar plate ligament.
You have to figure out first and foremost if you really have a plantar plate injury and not some other injury like a neuroma.
This is part of what we teach you in the Plantar Plate Injury Course for Runners.
Then you have to do a few simple tests and make an evaluation to determine whether or not your plantar plate ligament is partially intact, and actually functioning…not.
Provided that the plantar plate ligament is only partially torn, or it is just a Grade 1 sprain, or maybe even a Grade 2 sprain, you just have to be diligent about decreasing the pressure and tension on ligament so that it can start to heal.
This is also part of what we teach you in the Plantar Plate Injury Course for Runners.
You have to understand that the entire realm of plantar plate injuries can be extremely frustrating for runners.
First of all, most of the runners I talk to during phone consultations and webcam consultations really don’t even know how bad their particular injury is, at the stage they are in today. No doctor has really given them a straight answer.
And if you just step back and think about that for a second it doesn’t make any sense that you should expect you would be able to develop a plan of when you can get back to running if you don’t even know how bad the injury is.
But you can figure out.
Once you figure out how bad the injury is, you can start figuring out how aggressively you need to treat it so you can get back on the path to healing.
Even while you’re trying to figure all of that out, and then as soon as you start healing the plantar plate ligament you need to work on strengthening and maintaining everything else in your body so you can return to running as quickly as possible.
The bottom line is you to figure out how bad your plantar plate injury really is. And if your doctor can’t help you figure that out, you need to get a second opinion, or you need to figure it out on your own.
If you do that, you can get it to heal. You can decrease the stress and strain on the plantar plate ligament. Then you can continue to ramp up your activity from there so you can get back to running.
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!
Remember, it’s not really that complicated. When you have a plantar plate sprain and you want to get back to running, you need to confirm you have the right diagnosis.
You need to decrease some stress and strain to the plantar plate ligament, decrease the inflammation around the joint and then follow a very structured return to running that will allow you to retain your aerobic fitness, rebuild your running fitness and prevent you from getting another overtraining injury.
But if you do that, you can heal the plantar plate ligament and keep running!
