Do bunions cause plantar plate sprains in runners? That’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
One of the most nagging most difficult to deal with injuries when you’re a runner is something called a plantar plate sprain. And the plantar plate ligament is on the bottom of the foot, usually the one at the base of the second toe is the one that’s a problem.
When you get a sprain at the plantar plate ligament it becomes very painful. It hurts when you run, you start running less, you start running slower, but it doesn’t get better. It becomes a very nagging injury that can drive you crazy if you have an event you need to train for.
One of the questions I got from a runner who actually had one of these injuries who had bunions, just asked me, does the bunion cause it and I was like, this is a really dangerous question because in short, it can contribute to it, but it doesn’t cause it. But she had been running for a year. She qualified for Boston every year for more than a decade and she’s always had bunions. She’s never had a plantar plate injury before.
In her case, I just said look, think about that. If bunions cause plantar plate injuries and you’ve been running high mileage for many, many years, and you’ve never had a plantar plate sprain, it just doesn’t follow that bunions actually caused them now training errors caused them. I got one myself. I don’t have bunions, but I did get a plantar plate sprain one time running too fast down a specific trail that has lots of steps cut in it. Wearing shoes that were too flexible basically, and my foot hit the edge of one of those steps, dinged the plantar plate and I got a plantar plate injury.
I got it better by doing all the right stuff that I explained in the plantar plate course but that’s not the issue here. The issue is to understand why this is so important that you know bunions don’t really cause plantar plate sprains.
What can happen is this, plantar plate injuries are pretty common. Bunions are also very common. The reason we say they contribute is that what happens is that this bone right here actually drifts in this direction. So, the bump over here sticks out, the big toe gets drifted over and you get this funny looking thing called a bunion. But the further over this moves and the more flexible this becomes, the more it moves out of the way when you run that move is forced to your plantar plate on the bottom of your foot.
So, when you go see a podiatrist, they’ll say, “Well, you know, you have this kind of unstable bunion here. It’s moving out of the way all the forces go into your second metatarsal bone, and that’s putting pressure on your plantar plate and then when you roll off of it because your metatarsal isn’t doing what it’s supposed to do because you have a bunion, then you got the plantar plate sprain because of the bunion. So, what we need to do is we need to take you into the operating room, do a bunionectomy, remove the bunions, cut the bone, move it over, put a screw in it, straighten it, so it will actually share the weight again and then you won’t have any more issues with your plantar plate and it’ll heal right up.”
This is fixing a bigger problem that’s not actually symptomatic with surgery to try to get a little problem to go away. In my mind, that doesn’t make sense. So, that’s the reason I think it’s important for you to understand this episode. If you’ve had pain at the base of the second toe that you’ve been told it’s a plantar plate injury, and you actually have a bunion as well, if you go see a podiatrist and somebody’s going to talk you into doing surgery and it may not even be necessary.
Remember, if you’ve been running for many years with buttons and never had this problem before, it doesn’t mean that you’re necessarily going to get it again. I’ve never gotten a plantar plate sprain again, so hopefully this helps you understand more about plantar plate injuries and how they’re related to bunions or how bunions don’t necessarily cause them and you found it useful.
If you haven’t checked it out, you might want to check out the plantar plate masterclass. But if you know somebody that has pain that they’ve said they have a plantar plate sprain and they think they have bunions, you might want to share this episode with them if they’re a runner.
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