Is inflammation good or bad for a plantar plate sprain? Well, that’s what we’re talking about today on the Doc On The Run podcast.
I was just on a call with a runner who has a plantar plate sprain, and he’s trying to figure out what to do. There are lots of things that you can do to address inflammation that are commonly recommended by physicians. Icing, contrast bath, anti-inflammatory creams, medications that are anti-inflammatories, anti-inflammatory injections. There are lots of different approaches that we can use to manage inflammation, reduce inflammation, and hopefully make your condition better.
But he had a great question. Is inflammation really bad or is it good when you have a plantar plate sprain? The short answer is it’s both. It depends when and with most treatments, it’s not just that you do the right thing. It’s that you do the right thing at the right time because if you do the right treatment at the wrong time, it can actually make your condition worse, and the plantar plate sprain is no exception.
Now, the inflammatory phase you have to remember is the very first healing phase of any kind of tissue. It is the first phase of wound healing when you have an abrasion, if you fall off a bicycle and you skin your knee. It is the first phase of healing when you have a plantar plate sprain, or a muscle tear, or a stress fracture, or anything. You cannot have healing happening without the initial inflammatory response. That’s part of what starts the entire process.
In the short term, it’s definitely good. So if you have an injury and you have a little bit of inflammation and swelling, yes, that hurts because it causes distension and swelling in the tissue, but it does kick off the healing process, and it’s good. Lots of Eastern medicine preaches that the heat applied to a wound or to an injury can actually increase the inflammation and increase the speed of healing and that’s one approach.
Much of Western medicine says, “Well, inflammation is the source of all chronic disease. It’s bad. It causes things like cancer and heart disease and diabetes and all this other stuff. So you need to do something to stop all the inflammation.” Well, that’s sort of true, but it’s applying chronic disease to an acute injury, like a plantar plate sprain, and that’s not really the right way to think about it.
The way that inflammation can be bad for a plantar plate sprain is really simple. When you get that injury, part of what happens in the inflammatory phase is that you’re trying to clean up the damage and you’re trying to get rid of tissue debris. So if you have a torn ligament or any structure made of collagen, you have to have enzymes that actually degrade that piece of tissue and dissolve the collagen. So your bloodstream can remove it. That’s part of the tissue damage removal process.
Well, if you have an inflammatory condition, because you’re irritating an inflamed and irritated piece of tissue, like the plantar plate sprain, over time that can make it worse. Here’s how. Let’s say you’re out on a run. You step on a rock or you land on the ball of the foot just wrong, and it stretches stresses and strains the plantar plate ligament.
Then you have some swelling in the foot, around the plantar plate, ligament around where the second toe attaches to the foot and you think, “Well, it’s not that bad. It doesn’t hurt me that much and I have this race coming up, so I’m going to continue to train and just ignore it.” So you continue to run, you continue to train, it continues to stay swollen, it continues to stay inflamed for months.
Now, months of having that degradative enzyme in the inflammatory fluid floating around the plantar plate ligament can actually further weaken the collagen in the plantar plate ligament, and it can then stretch out or tear worse. That is how the chronic inflammation in that joint around the plantar plate ligament can actually make you worse if you’re a runner.
The short answer is it’s both. Inflammation can be good and it can be bad. It’s good for the short term, but it is not good over the long term. So if your plantar plate hurts and it’s continuing to bug you, don’t just ignore it, do something.
Now, if you haven’t checked it out yet, you should check out the Plantar Plate Masterclass where I go into a deep dive about what you, as an injured runner, can do when you have this condition and all the things you really need to think about to really make sure that you get back to running as quickly as possible. You can get it for free at docontherun.com/plantarplatemasterclass. So go sign up, and I’ll see you in the training.