Can a fracture in the metatarsal seem like a plantar plate sprain? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
There are times when you might have a fracture in your foot and your doctor wants to order an X-ray. There are other times when it’s extremely unlikely that you have a broken bone at all and it’s just a soft tissue injury in which case, the X-rays would be a total waste of time, money and frankly, unnecessary exposure to radiation. So, you always want to make sure that it’s really necessary to do X-rays before you get X-rays.
One of the questions I get a lot is when somebody has pain that seems like it’s a plantar plate injury, they want to know if it might actually be a fracture. And I have only seen one case where somebody actually had pain in the exact same spot you would have pain when you had a plantar plate injury.
Not surprisingly, if you press right on the bottom of the foot, right where the toe attaches to the second metatarsal where the plantar plate ligament is, it hurts. Now in this case, the guy actually had a tiny little chip fracture right under the plantar plate ligament and so when he pressed on it, it seemed like a plantar plate type of injury.
His story didn’t fit with that. So, I was suspicious that he had a fracture because of the way the injury happened. But if the only thing you said is where does it hurt when you push on it, and he had said it only hurts right here, I would have said “Yeah, that’s probably a plantar plate sprain.” But this is why you have to really take the whole picture into account.
In his case, he’s actually a running coach and he was doing a training drill where he was doing some skipping drills basically swinging his foot through barefoot on the track to warm up. And what happened is that as he was swinging through barefoot, the foot actually slammed into the track and it actually chipped the metatarsal bone, specifically the metatarsal head. And in that case, this is different.
It did hurt when he pushed on it, obviously but it was a different injury. It wasn’t a soft tissue injury. It wasn’t a plantar plate sprain and it had to be treated differently. So, when we got X-rays of the foot, you could actually see this little bitty fracture right there. But you have to get specific views to make sure you see it. In that case, we had to actually get a view of his foot called the sesamoid axial view where you pull up the toes and you’re actually looking straight under the metatarsal, which allowed it to look and see if the bottom of the metatarsal head is actually broken off.
Again, the reason I’m bringing this up is that it can happen extremely unlikely because I have only seen this once and his story fit more with a fracture than it did with a plantar plate ligament injury, which made it completely justifiable to get X-rays to take a look.
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