What’s the best imaging study for a runner who is suspected of having a plantar plate injury? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I know if you have been told you have a plantar plate sprain, you’re probably already really frustrated because these are really nagging injuries that are very difficult to get better while you’re running on them.
The bottom line is, is that you’ve got to make sure that it’s improving because in general, plantar plate sprains are either getting worse or they’re getting better. So, if you have like a little bit of pain and you just ignore it, you just run on it, it’s probably just going to get gradually worse over time because the chronic inflammation weakens that ligament as you ignore it, so you can’t ignore it.
But the trick is that if you are actually training, you’re running and it’s very slowly getting better, you’re probably going to be okay. But don’t just go run and ignore it. This is a high risk issue.
One of the questions I get all the time from runners is what is really the best study for a plantar plate injury. Many people think it’s an MRI. MRIs are very, I think over utilized for these injuries. And there are studies you can look it up I’ve talked about this in other episodes, there’s a study that actually showed that MRI missed the majority of tendon ligament tears, particularly in chronic injuries like a plantar plate ligament sprain, that happened a long time ago.
The longer it’s been, the less reliable the MRIs actually going to be. X-rays are also very unreliable because you’re only looking at bones. So, when doctors get X-rays of your foot and you’re trying to figure out whether or not you have a plantar plate ligament tear, you can only see secondary signs of it. Meaning that the toe’s sitting out of position because the ligament is stretched out in letting the toe rotate upward. Or you’re looking to see if he tore one of the collateral ligaments and so maybe the toes twisted sideways, but inflammation within the joint can actually push the toe in one direction. And so, the X rays are not really that reliable.
For me, I think the best test is really a diagnostic ultrasound. So, I actually carry one with me. I can actually look at your foot in person and actually put it on your foot and then actually stretch the plantar plate ligament while looking at it on an ultrasound and see does it open up or not? And if it’s intact and we see it stretch, but it doesn’t actually come apart, well then we know for sure there’s a difference between torn or not torn.
When you have an MRI as a static image, you’re not moving, you’re sitting still they tell you to sit still in the scanner, and when you do that MRI and you don’t really see it, it doesn’t mean that it’s not there. These are slices taken at different positions throughout the foot and so sometimes you can miss a teeny weeny tear. Sometimes it can look inflamed, but you can’t really tell if there’s a tear or not. That’s why I think ultrasound is much better and ultrasound is a live test. You can actually stretch and strain the ligament and you can really get a much better evaluation of the ligament than I think you can on an MRI. But that also is dependent upon number one, your doctor having an ultrasound using a unit and for them to actually be used to using it and somewhat competent in actually evaluating the images as they’re looking at it on the screen.
That’s why I think that the best imaging study for plantar plate ligaments and runners is really a diagnostic ultrasound. So, if you’re looking for a doctor who is going to evaluate you, ask them if they have an ultrasound, ask them if they can look at it and ask them what they see when they’re looking at it with you.
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