#513 Should a runner have surgery for a plantar plate tear? - DOC

#513 Should a runner have surgery for a plantar plate tear?

Should a runner have surgery for a plantar plate injury? That’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.



Before we get started in this episode I just want to let you know I created something for you that I think you might find really useful. It’s a presentation sharing the three main secrets I have discovered that are used by injured runners so they can maintain their running fitness and still recover from any over-training injury. Even if it’s a stress fracture, a plantar plate tear, a partial rupture of the plantar facia or Achilles Tendinitis.. this will help you get up and get moving!

So if you’ve been told you have to sit on the couch and wait for an x-ray or for something to change, you need to check this out.

I’ll explain more at the end of the episode. And let’s queue up the theme song and get started with today’s show.

This is a really simple question. Should I have surgery to repair my plantar plate injury? Well, there are a couple of reasons that you should consider surgery and they’re really simple. The first one is that if you have tried everything else and nothing will work. I mean, if you have honestly tried it, so saying you kind of messed around with a boot a little bit, or you sort of use crutches, or you sort of taped the toe or you sort of used some pads and you’re not getting better, that’s not trying it. You have to be honest with yourself about that. But when you have clearly failed all of the things that are non-surgical and you cannot get better, then surgery makes sense.

But surgery should not be taken lightly. There are lots of different surgeries that we can do. Now we can actually go in and put in some stitching to sew up the plantar plate. We can put in a little bone anchor to reinforce the plantar plate ligament before we sew it up, we can actually cut the metatarsal bone and shorten it to decrease some of the stress and strain. But each one of those various procedures has risks that could actually compromise your ability to run if you get some kind of complication.

So if your doctor says, “Look, nothing else is going to work. Surgery’s your only option”, well if you believe the doctor, then you should go ahead and have surgery. But I’ll tell you one reason why this appeals so much to runners and why runners keep asking me whether or not they should just have surgery. Well, we often think of it as the way we think about things like automobiles.

If you have a car that has a four wheel drive system, for example, and you push the button on the four wheel drive and nothing happens, what could be the problem? Well, maybe the switch is bad. Maybe the little computer in your car that actually controls the transfer case motor that sends power to both front and rear axles is bad. Maybe the transfer case motor itself is bad. Maybe the wire in between the switch and the transfer case motor or the wire between the switch and the module, one of those is bad. Maybe the fuse is blown, could be lots of things. But if you just have a blown fuse, all you do is take it out and put in a new one and then it’s working again. And so we always think that human beings act same way, but they don’t and  when you put in a fuse, the body doesn’t react abnormally.

Sometimes that can happen when you have a plantar plate repair. So if we put in stitches and you have a reaction to vicryl, the suture that we put in that’s absorbable, that’s a problem. If you have thick stitching and you get scar around it and it forms a lump that hurts when you run, that’s a problem. If you get infection and it doesn’t heal, that’s a really serious problem and if you have bone surgery and shortens the toe and the toes all wobbly and you get pain because of that, that is also a problem.

There are lots of things that can go wrong when we do surgery and that’s why I really say you’ve got to exhaust everything else first. So you have to think about all of the potential risks and then weigh whether or not it’s actually best for you. You’ve got to have a real frank discussion with your doctor about what your goals are. Not that you want the plantar plate injury to go away, but that you really and truly want to be able to run and you want to know, not is this going to fix the plantar plate issue? Am I going to be able to run marathons? Am I going to be able to qualify for Boston? Am I going to be able to do iron man triathlons?

You need to know what the issues are that you’re going to be facing afterwards because I have seen runners who have these injuries and cannot run at all. And if you get so much stiffness in that joint that it causes a different problem, you may not be able to run. At least not at the level that you expect. That’s why you got to talk to your doctor and then the last thing is you have to think about, plan for and prepare and make sure that you don’t get the dreaded postoperative weakness that plagues so many athletes who have surgery and have to take 6, 8, 10, 12 weeks off of training entirely while they’re healing that injury after surgery.

But obviously if you’re going to have surgery, you have to let it heal and you’ve got to do whatever your doctor says after the surgery. So you’ve got to work hard to build fitness before surgery. You’ve got to do a lot of stuff to maintain your fitness as you’re recovering immediately after the surgery and then you have to work hard to get back to where you were before. That’s just the bottom line.

Plantar plate repair can be a reasonable thing to do in terms of a surgical procedure, if you’ve really exhausted everything else and if, and only if, it clearly is worth all of the risk. But that is the only time you should really think about having a plantar plate repair surgery.

At the beginning this episode I told you that I have created a presentation that you really need to see if you are injured and are trying to figure out what to do next. You’re going to find really useful if you have an overtraining injury and you are told that the key is to sit still, rest, recover and, in short…do nothing other than watch your fitness evaporate.

It doesn’t have to be that way. I will show you 3 Secrets to Overtraining Recovery that injured runners use to maintain their running fitness and still recover from any overtraining injury. You can use the presentation get moving, maintain your hard-earned running fitness and get past any overtraining injury.

Registration is free just go to docontherun.com/overtrainingsecrets and sign up there.