Today on the Doc On The Run Podcast, we’re talking about plantar plate fraying on an MRI a runner with a stress fracture.
I just got a call off a runner who called me for a second opinion, who wanted to do a telemedicine visit because she got an MRI and she thought she had a stress fracture and there was some inflammation or edema within the bone on her MRI. But she was actually very concerned because one of the findings noted by the radiologist on the radiology report, said that she had fraying of the plantar plate ligament on the second, third and fourth metatarsal phalangeal joints.
The metatarsal phalangeal joints are just the joints where the toes connect to the foot at the ball of the foot. And at the bottom of that joint is where the plantar plate ligament sits.
Now I’ve talked a lot about plantar plate ligaments, I talk about all about in great detail about plantar plate injuries and runners and what you can do about it, how you can reduce the stress and strain and tension to the plantar plate ligament, all the things you can do to actually promote healing and maintain your fitness if you’re a runner. I talk about all that stuff in the planter plate course for runners, but this is the thing with the plantar plate ligaments… first of all, they are very small and they’re actually poorly visualized on an MRI.
When you get an MRI, when you go to see your doctor and you think you have a stress fracture or a plantar plate ligament sprain, or a torn plantar plate ligament, or an injury to the joint capsule, and your doctor gets an MRI, we as runners always want to believe that we’re going to get the full story and the complete picture from that MRI, but that is not always the case. And sometimes you can actually get information that you really don’t want and really don’t need. And fraying of the plantar plate ligament is one of those things that can lead you astray.
So in this case, this is a woman who’s been running, she’s been running a long time. She doesn’t have any pain at the plantar plate ligament area. There’s no pain on the bottom of the joint capsule. There’s no pain at the base of the toes on the bottom of the foot, but she has pain on one specific metatarsal bone on the top of the foot. And she has pain when she pushes on the top of the foot, but she does not have any pain at all when she presses on the joints at the bottom of the foot, toward the ground. And of course that’s where the plantar plate ligament is. So she went and got an MRI. She’d had an x-ray, the x-ray didn’t show anything. The doctor said, “You need to get an MRI so we can see if you have a stress fracture or not.”
And although there was no crack on the bone, on the MRI, there was this finding of inflammation within the bone. So what that means is it’s not really a true stress fracture. It’s actually a stress response, but what really confused her and set her off is that the doctor seemed concerned about this finding of fraying of the plantar plate ligaments.
The assumption is that fraying of the plantar plate ligament must problem.
But if you think about what fraying actually means, if you think about frayed fabric, what is it? It’s where you have some of the strands of the fabric start to come apart and it makes the edge of it kind of fuzzy. The plantar plate ligament is a structure that is just made up of collagen strands. The same way that fabric is made up of cotton strands or nylon strands or polyester strands. And so those strands, when they become cut or frayed or damaged, they get fuzzy and we call that fraying.
Now, when you look at a plantar plate ligament on an MRI, and there’s this finding of fraying, it just means that some of the collagen is fuzzy or coming apart a little bit. And we assume that it’s wear and tear. We assume that it’s excess stress and strain, but we don’t really know if it’s a new thing or a very, very old thing. It could be if you’re a woman in your forties and you’ve been running for many years, the fraying supposedly, of the plantar plate ligament could be very old, but we don’t know.
If you have an MRI and you have this incidental finding of fraying of the plantar plate ligament, but you don’t have any pain there. You don’t have any associated a signal change or inflammation showing up on your MRI in that neighborhood. It is unlikely that that’s the problem at all.
So in the case of this woman, that called for a second opinion, who we did a telemedicine visit, went through a whole MRI to look at it and figure out what was going on. That was not a problem at all. There was no pain there. There was no actual inflammation around that ligament where it showed fraying.
It is extremely rare that anyone with a plantar plate ligament sprain, a torn plantar plate ligament, or an injured plantar plate ligament in any capacity, is going to have injuries of all of them in the middle of the foot. It’s usually just one, most of the time, the overwhelming majority of the time in fact, it is just a second metatarsal phalangeal joint, where you have an injury to the plantar plate ligament. So I don’t get too concerned about fraying of the plantar plate ligament, particularly when we know that the patient has another problem, that’s causing all the pain when they run.
If you want more detail, you can check out the Plantar Plate Ligament Course, but you really have to remember that a lot of times an MRI will give you information that you’re not looking for. And that’s really not helpful in the first place. Make sure you pin down the doctor and really get a clear answer and explanation from them about why they should be worried about something when they have no pain in that area. That will definitely help you figure out what you need to do to get back to running as quickly as possible.
If you have a stress fracture, you’re probably really freaked out right now and think you’re going to lose all of your fitness while you heal. But it doesn’t have to be that way. I teach doctors how to help runners heal and maintain running fitness.
If your doc said “Stop Running!” You don’t have to stop running. You just have to reduce the stress to the injured bone so it can heal. You just have to be thoughtful about how you maintain your running fitness so you can keep healing.
Run without making it worse. The worst thing you can do is sit still, stop exercising and lose all of your running fitness. It is possible to maintain your running fitness while you heal your metatarsal stress fracture. This course shows how.
Enroll in the Metatarsal Stress Fracture Course now!
If you have a stress fracture
You’re probably really freaked out right now and think you’re going to lose all of your fitness while you heal. But it doesn’t have to be that way. I teach doctors how to help runners heal and maintain running fitness.
If your doc said “Stop Running”
You don’t have to stop running. You just have to reduce the stress to the injured bone so it can heal. You just have to be thoughtful about how you maintain your running fitness so you can keep healing.
Run without making it worse
The worst thing you can do is sit still, stop exercising and lose all of your running fitness. It is possible to maintain your running fitness while you heal your metatarsal stress fracture. This course shows how.
Enroll in the Metatarsal Stress Fracture Course now!