Could my plantar plate ligament been have injured long before I ever got an MRI? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was recently doing a second opinion consultation with a runner over webcam, and we were looking through his MRI. What we found was that he had what looked to be attenuation and a partial tear in the plantar plate ligament on his MRI.
There was a lot of inflammation around the ligament, not just within the ligament and one of the questions he asked me was really good. He said, “Could this have been an old injury like that had been something I did a long time ago, but now it just is kind of showing up now that I got this pain in my foot and the doctor isn’t really sure what’s going on. Is it possible that maybe that’s an old injury and not really the source of my discomfort right now?”
The short answer is yes. I see lots of things in runners and triathletes where they have plantar plate injuries and I get all of these things and reports and from other doctors that I don’t think really helped that much. One of them is fraying of the plantar plate and interestingly, I often see this evaluation or impression from the radiologist where they say they have fraying of the plantar plates, two, three and maybe even four as well.
What that means is that if this is your big toe, this is your second, that’s your third, fourth, fifth etc. Most people that have a plantar plate injury have a sprain to the plantar plate ligament the second toe. So, if you have fraying at the second toe and you’re afraid that the third toe and the fraying at the fourth toe, what that means to me is that’s probably just wear and tear. It’s probably not even what we call pathologic or it’s not really the problem.
So, maybe you stretched and strained the ligament and maybe you injured the synovial tissue on the inside of the joint. Maybe you have synovitis. Many times when I see this fraying of the plantar plate on two, three and four, and there’s inflammation in the soft tissue and within the joint itself, that’s really capsulitis and not even a plantar plate sprain on an MRI.
That’s one of the reasons I’m not crazy about MRIs for these particular injuries. So, the thing is, is that unless you had a previous MRI of that foot for a different injury, where you can actually compare and see, was there really this fraying before, did it look injured like this before, you don’t really know if it’s part of your current problem or not. So, you have to remember that not every weird thing we see on an MRI is pathologic, it may be abnormal, but that doesn’t mean it’s causing your trouble. Sometimes it’s just old, it’s still abnormal appearing but it’s an old injury and many times old injuries don’t fully change and become normal again on an MRI after many years.
So, you got to talk to your doctor about that. You got to explain to your doctor and think back, did I ever have any kind of injury that could have accounted for this change on the MRI, this showing up right now, because if you do the wrong treatment for a given problem, you’re probably not going to get better and you’re not going to get back to running as quickly as possible.
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