Today on the Doc On The Run podcast, we’re talking about whether or not you can do leg presses with a plantar plate sprain.
This episode comes from a question actually from a YouTube comment on one of the plantar plate videos in there, on the Doc On The Run channel. And the question was, “Can I do leg presses with a plantar plate sprain?” This is actually a great question because it’s really key that you maintain your running fitness when you get an injury that takes a long time to heal like a plantar plate sprain. But there are really two keys to healing a plantar plate injury. And that is to decrease the tension or the amount of stretching and the plantar plate ligament, and to decrease the amount of pressure and irritation or mechanical irritation from pushing on the plantar plate ligament.
Now, when you do leg presses, depending upon how you do them, you can cause a lot of pressure and tension to the plantar plate ligament. And so this is actually a great question. It seems really simple, but it’s not that straight forward.
So if you’re doing a leg press machine where you have your feet on a stable, big metal platform that pushes the leg press machine, one thing that you can do that will definitely decrease the amount of stretching of the plantar plate ligament is to keep your foot completely flat on that foot plate.
What I mean by that, is that if you keep your foot flat with your heels down on the plate and your foot in one position, and you push to the end where your leg extension, where your legs are straight, then your feet are flat, you’re really not doing much to stretch the plantar plate ligament in a way that would irritate it. Now, if you’re doing something like using some pads or some method of offloading, which of course is the fancy word doctors use for moving pressure to someplace else. Well, if you’re offloading the plantar plate and you have your foot on the foot plate, and it doesn’t really hurt when you push on the leg press machine and you’re keeping your foot flat, then that’s probably not going to aggravate it very much.
One of the worst things you can do when you’re doing this exercise is to actually push at the end of the range of motion, where your legs are already extended. A lot of people do this instinctively, trying to get that little, extra bit of effort in where you push your toes down, you press your toes down, you pull your heels off of the foot plate at the end of the leg press and that actually stretches the plantar plate ligament a lot because the heel is coming up off of the foot plate and it bends the toes right at the metatarsal phalangeal joint, which is right where the plantar plate ligament is sitting on the bottom of that joint. And it’s getting stretched when the toes come upward relative to the foot, or if the toes are on the foot plate and your heel comes up, same thing.
So you do not want to push and stretch and pull your heels off by pushing with your toes or sort of standing up on your toes at the end of that leg press motion. But if you can remove the pressure intention to the ligament, it will heal faster. So if you’re doing some stuff to reduce the pressure, it doesn’t hurt when you do it. And you do not push and pull your heels up off of the foot place to push down with your toes at the end of that range of motion, then that is the safest way to do it when you’re doing leg presses and you have a plantar plate sprain. Hope this helps.
Also, I’ll give you one other quick tip that might be really helpful when you’re doing these exercises on a leg press machine. If you do it, and you notice that you have a little bit of tenderness afterward or it seemed a little bit sore when you’re doing it, one thing you can do is just try to put more of the force on the other foot.
Just let your injured foot sit on the plate and kind of go along for the ride where you’re not really pushing that much, but you’re pushing hard with the other foot. That can help because it will really maintain a lot of strength in your non-injured leg, which of course is going to take more of the beating when you actually start running again. And there’s some research that actually shows when you have an injured extremity, like one foot and you actually work the muscles in the non-injured leg that you actually can maintain some muscle mass by default in the other leg.
So that’s probably beyond the scope of this talk, but just think about that when you’re on the leg press machine, and you’re first trying it out to sort of test the water, try to just let your injured foot go along for the ride. And that is the safest way to get started with the leg presses when you have a plantar plate injury. So take that and try it out and see how it feels.