#793 When should I give in and have plantar plate surgery? - DOC

#793 When should I give in and have plantar plate surgery?

When should a runner just give up and have plantar plate surgery for a plantar plate sprain? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



If you’re a runner and you get a plantar plate sprain, this is probably going to be extremely frustrating trying to get it to heal so you can get back to running. It’s a very small ligament. It does not really have a great blood supply and every time you take a step, you put pressure on it. Every time your heel comes up off the ground when you walk, you stretch it.

It’s really hard to keep it still because if you just wiggle your toes you’re stretching and straining the plantar plate ligament in some fashion. So, the thing is, is that because it is such a difficult injury to heal quickly, and runners typically have setbacks that frustrate them, it actually becomes pretty easy for a doctor to talk you into surgery to repair the plantar plate surgery.

The sales pitch is basically like, “Well, it’s taking forever, you’re not getting better. You had several setbacks, setbacks, let’s just go in there and sew it up. Let’s make it stronger. So, you don’t have to worry about it anymore.” Well, then you have to worry about other things like scar tissue, nerve entrapments, all kinds of risks of surgery.

If you can get it to heal without surgery, you’re definitely better. But then the question becomes when do you give up? When do you stop trying what we call conservative or non-surgical treatment and just throw in the towel and go to the operating room and see if that’ll fix it?

Well, really simple. You should only do that when the risk of surgery is less worrisome than the risk of not having surgery. And I really believe you should try everything else first because if your goal is to have the plantar plate fully repaired and stable, well, surgery is really the easiest way to accomplish that. Right? We’d sew it up, we stitch it together. We maybe put in a bone anchor to make it more stable.

But is that really your goal or is your goal to run? And then if your goal is really to run, not just to like make it look better on an MRI or an X-ray or something, then you have to think about whether or not surgery is really necessary for you to fully repair your plantar plate sprain so that you can run again anyway and if it really is necessary that you have full repair of your plantar plate so that you can run again is surgery the only way is plantar plate surgery, the fastest way.

The truth is that most runners never even think about this. You don’t even bring it up and talk to your doctor about it. So, I’ve seen runners that get very frustrated because they have surgery and it doesn’t go well. I’ve seen runners who are frustrated because they’re getting better slowly but they are getting better and their doctor’s still trying to talk them into surgery.

The main point is that you have to really think about what your overall goal is and you have got to discuss it with your physician. You have to explain it to your surgeon because if you really make it clear that your goal is to continue running marathons, continue doing Ironman triathlons or whatever, then they’ve got to understand that the goal is not to do the surgery that you should ask them is there a guarantee that I’ll be able to run after surgery if you do this surgery and if they say no, you should think twice about that.

Hopefully you found this use this episode useful and if you did, great! If you did like it and you know somebody that has this issue, please share it with them. Help another runner and if you want to learn more about plantar plate sprain issues specific for runners and triathletes, you can get that free at www.docontherun.com/plantarplatemasterclass. It’s where I go into a deep dive about all the issues related to plantar plate sprains specifically in runners. You can get it for free there so go check it out, and I’ll see you in the training.