Today on the Doc on the Run podcast, we’re talking about two ways you can modify a fracture walking boot if you have a plantar plate injury.
Today we’re talking about two ways you can modify a fracture walking boot when you have a plantar plate sprain. This is a great question that I got from somebody on a call who actually signed up and enrolled in the plantar plate class for runners. And so, he was going through the plantar plate course. He was actually trying to figure out what to do, and he was going to jumpstart the healing process by using a fracture walking boot.
I know you’re probably thinking, but wait a minute, this guy’s made a hundred episodes talking about how bad fracture walking boots are for runners and that’s true. But fracture walking boots are bad for runners when you use them for a long time, but they can be very, very helpful if you use them for a short time, and that’s what his plan was. But he tried it on and he noticed that he was feeling some pressure because the inside of the fracture walking boot is basically flat.
So I said, “Okay, well, look, there are a couple of ways you can, can change this. You can modify it and you can remove some of that pressure.” And it was good that he noticed that there was a lot of excess pressure on his injured plantar plate when he was wearing the fracture boot. Couple of ways to do this.
The first way, the simplest way, is what I have often done in clinic, in people’s living rooms when I see them and fit them for a fracture walking boot, and it’s a very simple way to do this. If you have a fracture walking boot and you’re trying to remove some pressure, all you’re doing is removing some material right under the plantar plate ligament and the toe that attaches to the foot right at the plantar plate ligament. It’s pretty simple.
Sometimes you can use an exacto knife. Most of the time, I use a scalpel because that’s what I usually have. You can use a dremel or a little drill with a grinding bur on it and effectively what you’re doing is you basically just put your foot in the fracture walking boot, you figure out where that toe is, you outline an area where the injured toe attaches to the foot and then, you basically just remove some of that material under that toe and the metatarsal head at the ball of the foot right where you’re having pain with the plantar plate.
If you do that correctly and you remove some of that foam material, either you just sort of scallop and shell some of it out or you grind it down and thin it out or if you just sort of cut out a big section of it, when you put the boot back on and your foot is in the fracture walking boot, you stand up, it should feel better. You should feel less discomfort because there would be less pressure and direct strain placed on the plantar plate ligament when you’re wearing the boot. It’s been modified in that way. That’s the first way.
Now, you’ve got to be careful because the material that’s in the bottom of the boot, the foam is usually EVA or ethylene-vinyl acetate, usually firm EVA. If it feels very stiff, it’s usually firm. But if it’s softer or medium EVA, sometimes it can collapse under the weight of your foot. Then, if you’ve had a fracture walking boot, you wore it for a long time you might notice there’s a perfect imprint of your foot in the boot and that’s because the EVA collapses over time.
Why is that important? Well, if you remove a bunch of that material and you expose the plastic foot bed underneath that foam, you’ll notice that it has a bunch of crosshatched ridges that are hard plastic that make the boot more stable.
Well, obviously, you don’t want your injured plantar plate standing on some plastic ridges so if you cut away too much of it, and it feels good initially, but then the EVA collapses under the weight of your foot and you start rubbing up against those ridges, that’s going to be uncomfortable. So you got to be cognizant of that. If you remove too much material, you can irritate a little bit, so you got to be careful doing that.
Second option, we’ll avoid that problem entirely. What you do instead is you add some material everywhere except where the plantar plate in that affected toe happens to be sitting in the boot. The way that I do this is I will have some felt material, have a roll of felt that I carry. I think it’s three-eighths-inch thick, firm, felt, and it has adhesive back. So I basically take the felt, put it down, put the boot on it, trace around it, cut out the felt, and then, I slide that piece into the boot on the foot bed.
Then I basically just look at it and I figure out where the patient’s foot is sitting and then, I just trace a section, cut it out and then put it back in the boot and stick it in with the adhesive. So remove the backing, stick it down and then, they put the boot on, and that removes all the pressure under that particular toe and the metatarsal where it attaches to the ball of foot, and it makes it feel a lot better. If you put it on and it feels better right away, you have less stress and strain on the plantar plate ligament. So the boot modified in that way might actually really speed this along quite a bit.
The whole name of the game with plantar plate injuries is to make sure that you remove the inflammation, remove the stress and strain to that affected ligament so that it can recover faster. That’s what I talk about in the plantar plate course for runners. That’s something I also talk about in the plantar plate masterclass. So again, you can get access to that free, just go to docontherun.com/plantarplatemasterclass, and you can access it there. I’ll see you in the training.