#570 Should I stretch the toe with plantar plate sprain? - DOC

#570 Should I stretch the toe with plantar plate sprain?

Should you stretch the toe that has a plantar plate sprain? Well, that’s what we’re talking about today on the Doc On The Run podcast.



When you get a plantar plate injury, the thing you’re trying to do is reduce the stress and strain on that injured ligament, more than anything else. So if you’re thinking about whether or not to stretch the toe or do something to try to help the condition improve faster, you really need to think about the mechanics that are actually involved when you have a plantar plate injury.

Let’s talk about that real quick. Now, when you look at the foot and you think about the foot and cross-section through the second toe, and you think about what’s going on in there, and what’s really at play, we’ve got a few things. So you have the second metatarsal bone, you’ve got the proximal phalanx bone, the intermediate phalanx, and the distal phalanx bone.

All these bones are lined up in the toe. You have the joint capsule that holds all the fluid inside the joint and then on the bottom, you have the plantar plate ligament. So the plantar plate ligament is basically pulling the toe down against the ground, right? So what I see sometimes is people think that they need to stretch the thing that’s injured. and a lot of times, what I see is people will actually pull the toe up. They’ll actually take the toe and they will bend it straight up, like this, where they’re really cranking the toe and they’re pulling it straight up. But what happens when you do that? Well, when you do that, the plantar plate ligament on the bottom, if it’s torn, you’re actually pulling it apart. You’re pulling it in the wrong direction when you stretch the toe up.

If you stretch the toe up, it’s going to put a tremendous amount of stress and strain on the ligament, because you’re pulling up and it’s just ripping that thing apart and that’s the last thing you want to do. Now, what’s a much better approach is if you need to stretch the toe and you feel like you need to stretch the toe and your doctor or somebody says you should stretch the toe, you want to stretch everything other than that. So all of the structures that oppose it, everything on the top, the extensor tendons, the joint capsule. All of the structures on the top of the foot that are in the opposite position from the plantar plate is what you’re really trying to stretch.

There’s a couple of ways to do that. So one thing you can do is just pull the toe straight down. But when you do that, you have to be careful because what happens sometimes is I’ve seen people try to stretch it and what they do is they grab the toe here, around the end of the toe and they pull the toe down. When you do that, when you actually just pull the toe down and you bend it at this joint right here, what happens is that as you contract the toe and you pull the toe downward at that joint, you can sometimes actually do an even worse thing where you’ve got it down like this, but then because you’re pulling the toe down, it actually starts to move the knuckle upward. What we call the proximal interphalangeal joint.

Now, you’re pulling down at the distal interphalangeal joint. But when you do this, if it actually contracts and pulls the toe upward toward the foot in a hammer toe configuration, that’s the worst possible thing because when you do that, again, you’re stretching and you’re pulling apart the plantar plate ligament because the place you’re trying to make sure you don’t do that is where the toe attaches to the foot at the metatarsal phalangeal joint or the MTPJ, which is here where the ligament is. So you’ve got to make sure that when you’re stretching the toe and you’re pulling it down that you keep the toe straight, that’s the big key. So make sure you keep the toe straight as you pull it down if you’re doing the stretch.

In addition, you can distract a little bit or pull the toe outward a little bit. I’ve seen people do that, who are doing it very effectively. They’re basically pulling out, but you don’t want to pull out immediately because if again, if you have an injury to the plantar plate if you have a little tear here, and you just pull the toe straight out while it’s in that straight position, you’re still going to distract and pull apart the plantar plate a little bit right there.

If you start distracting after the toe is actually sloping down a little bit. Well, that sort of pushes this together first and doesn’t really cause as much trouble. So if you’re going to distract it, you want to make sure that the toe is pulled downwards slightly or plantar flexed a little bit before you actually distract or pull the toe out away from you and away from your foot. Those are really important points.

So the short story is that yes, many times if you’re doing stretching to try to mobilize that toe in a way that actually reduces the contracture on the top of the foot, that will really help to decrease some of the stress and strain on the bottom of the foot where the plantar plate ligament has been injured. But you’ve got to be careful about how you do it.

Hopefully this will help you understand that a little better. If you haven’t checked it out, check out the Plantar Plate Masterclass, it’s a deep dive I spend about half an hour going through everything you need to understand as a runner who has a plantar plate sprain. You can get it for free at docontherun.com/plantarplatemasterclass. So go sign up and I’ll see you in the training.