Why do plantar plate sprains take so long to heal? Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.
One of the worst injuries you can actually get if you’re a runner is a plantar plate ligament sprain. The plantar plate ligament is a very small ligament on the bottom of the foot, where the toe attaches to the metatarsal phalangeal joint, right at the ball of the foot. Now these can happen for lots of different reasons but it’s a very small structure and the unfortunate reality is, is that every single time that you stand, you’re stepping on the ligament.
Every single time your heel comes up off the ground and your toes are on the ground, you’re stretching the ligament. And so every time you take a step, walk, change direction, do almost anything, you’re actually stressing and straining the plantar plate ligament. They also do not have a fantastic blood supply and there’s a lot of mostly collagen in that structure and so it takes a long time for them to heal typically, and that can be extremely frustrating.
The thing is, is what I see with runners who call me for a second opinion, it’s not that they haven’t been given the right information. It’s that they kind of throw in the towel a little bit too soon. What I see happening over and over with runners is, they get a plantar plate ligament sprain. They go see the doctor. They use a fracture walking boot for a few weeks. They improve some. They get out of the boot. They start doing too much, a little too early, and they get a big setback. Sometimes this will happen over and over and over, literally over the course of several months and every time they get a setback, they get a little more frustrated, a little more worried, and they start to wonder about surgery.
Well, I can tell you that it’s been a long time since I’ve actually done surgery on a patient for a plantar plate ligament sprain because your recovery can be lengthy and it can be risky. And so most of the time, I try to get runners to improve without surgery and most of the time you can improve without surgery. I’ve had a plantar plate ligament sprain myself. Now I used pads for months after it was actually “healed.” I used tape to stabilize it when I would run, particularly on trails, for months after it was healed because I did not want to get one of those setbacks.
So you’ve got to understand all the details about the plantar plate ligament, about why it’s so difficult to heal and everything that you can do in that process of recovery, to make sure that the rest of your body, and in particular, all of those structures in the foot that helps support and stabilize the plantar plate ligament, that all those other things in your foot, the muscles, the tendons, ligaments, the bones, everything else, you need to make sure that you maintain the fitness and strengthen it further, so that those other parts of your foot can better support and protect that strained plantar plate ligament when you actually resume your activities of running. That’s really crucial.
If you haven’t seen it, go check out the Plantar Plate Sprain Masterclass that I created for runners. It’s free. You can get it at the bottom of the show notes for this particular episode, but go check it out. You’ve really got to understand the details about this particular injury, if you want to get back to running, without spraining it again. That’s the crucial piece, so go check out the masterclass and I’ll see you in the training.