Today on the Doc on the Run podcast, we’re talking about what kind of injections might help a plantar plate injury.
Today’s episode actually comes from one of the live Q&As I did with course members who are actually enrolled in courses like the Plantar Plate Sprain Course for Runners or the Metatarsal Stress Fracture Course.
So I do live question-and-answer sessions with people who are enrolled in those courses to answer specific questions if they think there’s something they don’t really understand from the course material. This is one of the questions that was posed, and it’s a great one, so I thought I’d share it with you here.
“One of my friends said that I could get an injection to help my planter plates sprain heal faster. What is that injection?”
Well, good question. I can tell you that the most common kind of injection that’s performed is a corticosteroid injection or a cortisone injection. What that is, is a mixture of local anesthetic and a corticosteroid that is a powerful way to reduce inflammation just within the joint.
Now that can be a good thing because if you have a lot of inflammation, if you only have capsulitis and you don’t really have a tear of the plantar plate or a true sprain of the plantar plate ligament, and you inject corticosteroids into the joint, it calms it down very, very quickly and feels a whole lot better, really fast.
The problem is, is that corticosteroids are also very effective at decreasing the strength of collagen bonds. Since the plantar plate ligament is basically just a big band of collagen that’s all connected with a whole bunch of little bitty collagen strands and collagen bundles, well, if you do have one of those little bitty tears within the plantar plate ligament and you inject corticosteroids into the joint and it makes that weaker, it could actually make the tear propagate or get bigger. That, obviously, would not be helpful.
A lot of the people I’ve seen who have really bad plantar plate injuries where they need to have surgery to put it back together, it seems like they’ve had corticosteroid injections at some point along their course of treatment. Again, the goal is to get back to running so you don’t want to do something that’s going to jeopardize that.
Now, having said that, if you had a scenario where you had been training your whole life to qualify for the Boston Marathon, you qualified for Boston, you’ve got a plantar plate injury, I would have a long discussion about whether or not it’s really worth that or not.
If it’s worth it to take the risk, to feel better for one specific race, that’s really a once-in-a-life kind of event, well, then it might be worth that risk. But you have to weigh the risk of feeling better for that one event versus the potential of making it worse, and then having a lot harder time to get it to heal completely later.
The other type of injection that could be helpful would be something like a platelet-rich plasma injection, or an amniotic fluid injection, or stem cell injection, one of these other kind of injections that’s supposed to actually stimulate healing and stimulate repair of the damaged collagen within the plantar plate ligament. That’s completely different. Now that actually has a little bit different course of recovery.
If you have a platelet-rich plasma or PRP injection, it actually causes an intense inflammatory response initially because you all these growth factors and stuff that we inject in there with the platelets that cause this sort of cascade of healing, but it converts it from what was kind of a chronic non-healing wound to an acute wound that is actually going to start to heal, but it sets off an inflammatory reaction.
So much of the time when you do that, it actually gets very inflamed, it’s pretty angry, it feels really flared up, it feels more tender in the first few weeks following the injection, and it doesn’t feel better. So you would definitely not want to do that kind of injection right before an event like Ironman Hawaii, or the Boston Marathon, or the London Marathon, or something like that.
You have to weigh the potential benefit versus the risk, and so it’s really important you talk to your doctor, not about the specific treatment, not about the specific injury, but about your specific goal. Then you can really come up with an answer and try to figure out whether or not that specific treatment is going to get you to your goal or not. That’s really the key.