Today on the Doc On The Run Podcast, we’re talking about we’re talking about whether a plantar plate sprain is caused by tight calves (or other way around) in runners.
Does a plantar plate sprain cause tight calf muscles or is it the other way around? This was a great question. This was one that was sent in by somebody who was watching one of the YouTube videos. And you have to understand that a plantar plate sprain is caused by excess stress applied to the plantar plate ligament. So does a planar plate sprain cause the tight calves or is it the other way around? And this really is a great question.
Here’s how a planter plate sprain can lead to tightness in the calf muscle or a calf strain or even Achilles tendonitis. And so the deal is this, is that you think about the fact that you get a plantar plate sprain. So let’s assume that you get the plantar plate sprain for some reason. And that actually is causing the problem with the Achilles tendon or with the calf muscle.
Well, the way that would happen is this. You get a sprain of the plantar plate ligament, you get an injury to the joint capsule at the ball of the foot, close to the toes. It’s at the end of this lever attached to your leg that we call your foot. And so, if that that spot gets injured and you’re trying to walk or run, well what will you naturally do? Whether you think about it or not, you’re going to pull the foot away from the ground, try to decrease the amount of pressure applied to that spot when it’s in contact with the ground.
And as a consequence, you’re basically pulling your foot upward away from the ground to decrease the pressure to the injured plantar plate ligament because it hurts less. So you’ll do that unconsciously. You’ll do that as a form of what we call compensation, which is really just a fancy term for limping in order to keep pressure off of that painful spot. When you do that, it’s basically putting excess tension into the Achilles tendon and the calf muscle has to work harder because it’s fighting the temptation to pull your foot down against the ground and push off.
And this tighter position that it’s been placed in because your foot is pulled up and the Achilles tendon is under greater tension. So that can lead to some irritation of the Achilles tendon or a calf strain or tightness in the calf muscle because you’re actively firing it. You’re not just stretching it, you’re actively firing it against resistance. So that can also happen from a different perspective where you have the reverse happening. Where you actually have tight calf muscles or you have a tight Achilles tendon that is actually pulling your foot down with greater tension.
So that is the other way that this can actually happen. And when you have a tight Achilles tendon, what’s really happening is that the Achilles tendon is pulling upward, where it attaches to the heel bone, pulling your heel up in greater tension, away from the ground. That of course drives your forefoot down into the ground. Now, this is a condition that doctors, we call Equinus Deformity and the term equine, of course, refers to a horse and horses walk in equinus or they walk up on their toes. So basically all horses, as a natural condition, have this Equinus Deformity and an equinus type gait.
So if you’re always applying pressure to the toes by always pulling up on the heel bone due to a tight calf muscle or a tight Achilles tendon, you’re simply driving the plantar plate ligament down into the ground with more force. That means that you’re basically pushing the metatarsal down against the ground and what’s getting caught in between as the plantar plate ligament. So that of course increases all of those forces applied to the plantar plate ligament when you run, when you walk and make it more prone to injuries like a planter plates sprain, a plantar plate tear or even a plantar plate rupture.
So that’s how that can happen and they are intimately related. So it’s a little bit of the syndrome of the chicken or the egg, but you have to really think about what is at the root cause of your plantar plate injury, if you get one. So the same way that caused it, if it’s from too much stress and strain from the tight Achilles tendon, then obviously if you want it to get better and you want it to go away and you want it to stay away, then you’re going to have to address that at some point.
So if you have a tight Achilles tendon leading to over irritation and inflammation and even a stressor strain or injury to the plantar plate ligament and your doctor tells you, all you need to do is sew up the ligament, well, you haven’t removed the root cause of the problem later. So that’s some of the stuff we talk about in the Plantar Plate Spring Course for runners. You just really have to understand what to do to decrease the inflammation to the plantar plate ligament, so it can start to heal and progress onto a healing phase, instead of being stuck in the inflammatory phase.
You have to understand how to decrease the stress and strain applied to the ligament, so it can actually start to heal without all that ongoing irritation and stretching and prevention of the collagen from forming to actually repair the ligament, if you really want to keep running. So. That’s what the Plantar Plate Course actually teaches you. But all of these are important points you have to think about. Not just how to get it to heal but what caused it in the first place.
If you a tight Achilles tendons or tightness in the calf muscle, you have to dress that, too, if you really want to get back to running as quickly as possible.
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!