What are two ways capsulitis can actually lead to a plantar plate rupture. Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get a plantar plate sprain that’s probably going to be really frustrating because it can take a long time to heal them, particularly if you’re not paying really close attention. And because of that, many people get frustrated and they either want to go to the doctor and have them do some kind of quick fix, or they want to just ignore it and run on it because it doesn’t really hurt that bad. Both of those are bad ideas and I’m going to explain why in this episode.
The first thing is, is that let’s say that you get a plantar plate injury. You have a little aching at the base of the second toe. It hurts a little bit in the ball of foot when you’re walking up a hardwood flooring, you’re standing on tile, you’re walking upstairs barefoot, stuff like that, but it’s not really killing you. And you can run on it and you just noticed that it’s a little bit achy while you’re running and maybe it’s a little bit achy afterward. But again, it’s not that big of a deal, it doesn’t hurt that much.
Is that a problem? Well, the short answer is yes. What happens is that when you get a plantar plate injury and you get inflammation in the joint, you get inflammation all around the joint and not inflammation over time, if left unchecked, can cause damage. The reason for that is you have an enzyme in the inflammatory fluid called collagenase that basically dissolves collagen.
Well, the plantar plate ligament is made up almost entirely of collagen. So, you have this little bitty band of tissue that’s supposed to help hold your second toe down against the ground. And when you have it marinating in collagenase because you just ignored it, let it swell, you keep running on it, and you think it’s not that big of a deal. Well over time, it will get stretched out and potentially even rupture.
That weakened degenerated plantar plate ligament is going to stretch out and get weaker or rupture completely if you stretch it enough. And if you stress it enough, that can be for something simple. Maybe you don’t really think it’s getting any worse because it hasn’t really hurt any worse but then you’re running on a trail you step on a rock and you twist off a root or something like that, or you change direction on a driveway cut out and suddenly you have a plantar plate rupture. That’s a real problem. Now you have a toe that’s going to be very unstable that might actually need surgery.
A second way that they all that, the capsulitis or the inflammation in the joint around the base of the second toe can cause a plantar plate sprain is when you get frustrated and go to the doctor and you tell him you want a quick fix. You go in and you tell him it doesn’t really hurt that much but it’s been nagging, it’s been going on a while. They look at you, they push on the toe, they move the toe, they don’t really think you have a rupture of the plantar plate ligament. They say, Well, you probably just have some chronic capsulitis. So, what do you do? Well, they’d say, Well, we can inject it. We can inject some cortisone in there that will shut down all the inflammation. It’ll stop it from swelling and it’ll fix your problem. He said, Great do that.
They inject it. The swelling goes down, the pain goes away and a few days later, you think problem solved. Well, yes and no. What you’ve done is you’ve actually stopped the inflammation in that area, and you shrunk down the synovial tissue that was causing pain related to the inside of the joint capsule. But if any of that stuff is around the plantar plate ligament or if you had a little partial tear in the joint capsule and it leaks out around the plantar plate ligament, well then what happens? You get weakening of the collagen because of the cortisone injection and then it can actually, well number one, it doesn’t hurt so you go run more and you’re training harder and you’re probably trying to make up for lost time.
When you do that, predictably, because you want your fitness back when you do something that stresses it too much, and then it ruptures. So, it doesn’t rupture from the workout per se and it doesn’t rupture from the injection per se. it ruptures from the combination of the two. So, chronic inflammation can reduce the strength of the plantar plate ligament because of the enzymes that are in the inflammatory fluid and cortisone can reduce the strength of the plantar plate ligament because we know that it can weaken collagen. That’s a problem in both cases.
The main thing you have to do when you have a plantar plate sprain is you paying real close attention. You have got to understand that all you really have to do is reduce the discomfort, start exercising, monitor your symptoms very closely and make sure that you don’t stress it in the same way that caused the injury in the first place. You want to understand the whole framework and strategy that I always use with injured runners and have this problem. You can check out the plantar plate masterclass. You can get it for free at the www.docontherun.com/plantarplatemasterclass. So, go sign up and I’ll see you inside the training.