#766 Should a runner have surgery to shorten a long second metatarsal bone? - DOC

#766 Should a runner have surgery to shorten a long second metatarsal bone?

Should a runner have surgery to shorten a long second metatarsal bone? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



Today’s episode actually comes from a discussion that I had with a runner who did a second opinion call, and she was considering surgery because she’s had a plantar plate sprain. And her plantar plate sprain was not that bad, but it’s pretty common that if you have a plantar plate sprain and you’re having trouble healing it, the doctor may recommend a number of different surgeries and one of those surgeries is where we actually shortened a bone to actually decrease the tension and pressure on the plantar plate ligament.

Let’s talk about how that works. When you look at the foot, you have all these bones in here, what we’re really talking about here is just this area where your second metatarsal bone lines up with all the bones of the second toe. On the bottom of the foot, that’s where the plantar plate ligament is. If you look at the foot from the side, all these bones point down toward the ground.

The second metatarsal bone is longer, so if we make a cut parallel with the ground in there and then slide it backwards, it not only slides it backwards, but it slightly lifts it up. When we cut it, it  also basically the saw shaves away part of the bone as it goes through, so it actually shortens it just because of the blade of the saw going through it.

How does this help? Well, since you shorten the bone and you move the plantar plate ligament up a little bit away from the ground, that decreases the direct pressure on the platter plate ligament. When you shorten the bone, it can also decrease the tension on the joint capsule which actually puts less stress and strain on the plantar plate ligament.  So, that’s the upside.

What’s the downside? Number one, you have surgery. Number two, you can’t run at all until the surgery heals. Number three, you can get complications, lots of them, because we start monkeying around with the mechanics and configuration of your foot in a way that we say it’s going to help one thing, but it could cause lots of other problems.

The first is that all that stuff cannot heal correctly, and you don’t get back to running because you have a different kind of pain or pain at the surgical site. The other thing is that I don’t think you should have surgery to reconfigure the structure of your foot unless that one problem has happened over and over and over.

So, let’s say you had a plantar plate sprain, but this isn’t the first plantar plate sprain. This is like your fourth plantar plate sprain or maybe you had a plantar plate sprain recently but previously you actually had a second metatarsal stress fracture because it was too long. Now, let’s imagine also you have a plantar plate sprain right now on the second. If you do, the doctor says, “Well, you got too much pressure here. But then you happen to have already have a stress fracture on the third and fourth metatarsal next to that one.”

If that’s true, what does that mean? That means that when you were running before, you have too much stress and strain on the third and fourth metatarsal. So, if you do surgery to shorten the second and reduce the amount of workload that’s applied to that bone, where do you think that workload goes? Straight over to the third and fourth metatarsals and if you already had a stress reaction or a stress fracture with one of those, you’re way more likely to get one of those later.

You really have to think about all these little pieces of your puzzle when you’re trying to figure out what’s really necessary to get you back to running as quickly as possible. So, in short, if you’re absolutely convinced, you’re never going to be able to run unless you shorten that metatarsal, that’s when you should have surgery. But if you’re doing it just because it might help your plantar plate ligament heal a little faster, I think that’s really really risky. So, make sure you get a second opinion.

If you haven’t checked it out yet, if you’ve got this kind of injury, you might want to check out the plantar plate masterclass. You can get it for free at docontherun.com/plantarplatemasterclass.

But if you liked this training, if you liked this episode, please like it, please subscribe, share it with a runner who needs to hear it and I’ll see you in the next training.