#574 Best exercise for plantar plate sprain in runners - DOC

#574 Best exercise for plantar plate sprain in runners

Today on the Doc On The Run Podcast, we’re talking about the single most effective exercise to support the plantar plate in runners.



The plantar plate ligament is a little ligament on the bottom of the ball of the foot, right where the toe attaches to the foot and it actually supports the toe by helping to hold it down against the ground or resist what we call dorsiflexion, where it gets pulled up away from the ground. That important ligament, even though it’s really small can cause a whole lot of trouble when you actually injure it and you get a plantar plate sprain.

So what does it look like? Well, I’m going to draw some pictures to hopefully explain a little bit about this, and show you some exercises that might help. First thing is we look at your toe in cross-section, what you have in here is the second metatarsal bone and you have three bones in the toe, you have the proximal phalanx, the intermediate phalanx, and the distal phalanx and then you have a joint capsule that holds all the fluid in there. The plantar plate ligament is on the bottom of there, like this.

What the plantar plate ligament does is it actually restricts motion and prevents motion in this direction, so if you think about that’s really simple. If you want to support that ligament, all you need to do is strengthen everything that might actually help hold the toe down against the ground. So you want to strengthen any muscle that can actually hold the toe against the ground with one big exception. You have to make sure that when you do this, this is crucially important that when you’re trying to strengthen muscles that hold the toe down against the ground, that you are not strengthening muscles that can actually injure the ligament and it’s very easy to do that.

For example, you have a couple of different where you have lots of different muscles in the foot, but the ones that we’re really thinking about right now that are most important are the ones that are what we call intrinsic muscles that start down here where the muscle belly is back here attaching to the heel bone and then that tendon comes all the way out and attaches on the bottom of the toe here.

What that means is that when it pulls, it actually pulls the toe down right here, exactly in the place that you want it to pull down to support that plantar plate ligament. What you do not want to do is take one of the big, powerful muscles that’s behind your tibia, behind your shin bone deep to your calf muscle up here called the flexor. Well, it’s just called the flexor. So flex for pull-down. Flexor digitorum for toe as in digit and longest because it’s the, you guessed it long one.

Then this one is actually it also flexes or pulls the toe down, so that’s the flexor. It’s one of the digits or one of the toes. So it’s called the flexor digitorum brevis. Now, the Brevis is your friend here. The longus, there’s your enemy. You do not want to strengthen the longus. The longus because it comes down, curves around, and then goes all the way out and attaches at the end of the toe, it actually causes the toe to buckle.

So when you’re doing this, this is a crucial point that you want to remember, do not buckle the knuckle. That’s the important thing you have to remember. So when you’re doing the exercises I’m going to show you and demonstrate for you, you want to make sure that you do not buckle the knuckle. If you do that, what you’re doing is you’re actually strengthening the long one.

Your hand is the same as your foot. It’s got the same number of bones, same kind of structure, and all that. But basically, what we’re looking at is that when you have your foot and you pull the longest, it actually cranks the toe up into a hammer toe. That is very, very bad. So when you get a plantar plate sprain, and it goes really bad, you wind up getting this thing called pre-dislocation syndrome and what happens is that when you look at it, you buckle the knuckle when you’re firing the longus, because the longus is going all the way out to the toe. It’s pulling in this direction.

The longus is doing that and what does it do? Well, it cranks the toe up into a hammer toe, like that and what does that do? Well, it actually pulls the plantar plate ligament apart. So you do not want to do that. That’s the longus, that’s a bad, bad thing. Every time you do that, if you’re doing exercises where you’re scrunching towels, you’re trying to pull the towel toward you with a towel on the floor or something. Then you’re actually crunching the toes up and they’re bending like that, where you’re buckling the knuckle here, then you’re strengthening the deforming force and you’re going to make the problem worse.

Do not do that. Instead, what you want to do is this, you want to basically aim for keeping the toe straight. So this is your toe and it’s sitting on the ground. You want to keep the toe straight so that all three of these bones are lined up like that and then you want to try to lift the foot up, is what you’re trying to do. That’s how you exercise the Brevis because the Brevis’s job is to hold this toe down against the ground, by pulling at the base of the toe.

What you do is you put your foot on the ground, your heel is on the floor, you put your toes on the floor and you want to basically pull the ball of the foot, where the knuckles come up off the ground while keeping your toes straight and keeping them flat. Again, if they crunch up and they buckle, huge problem. That’s going to make it worse.

Do not do that exercise. So you’ve got to practice to this and sometimes what you have to do is put your foot down and it’s not going to feel like a big exercise. It’s going to feel very subtleand it takes a lot of specific control to get that muscle to fire, but it’s worth the effort because it will strengthen the intrinsic muscle in the foot that actually supports the plantar plate ligament. But only if you do it that way. If you do it incorrectly, it can make the problem worse.

If you don’t think you can do it right, ask a doctor or physical therapist. You can come to the runner’s aid station, they’ll show you how to do it in a webcam call. But you’ve got to make sure you’re doing it correctly. That’s really important and if you do this, though, it will strengthen and support the plantar plate ligament. That’s really important if you have a plantar plate injury and you’re a runner who really wants to get back to running.

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