#881 Can I run in zero drop shoes after plantar plate sprain heals? - DOC

#881 Can I run in zero drop shoes after plantar plate sprain heals?

Can I run in zero drop shoes after a plantar plate sprain heals? Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.



I was just on a call with a runner, and he has been doing really well. He had a plantar plate injury, it has been bothering him for about a year and a half and we did a series of calls to talk about some things that he could do differently to get him moving in the right direction and finally, it is.

He is a little gun shy because he did take over a year where it was not improving at all with some standard treatments. And so, he is being cautious but he rightfully so. He has had a lot of trouble with this thing and now it is doing great, and he wants to make sure he does not mess it up.

He asked me a great question when I was on a call with him this morning. He said, “Can I run in zero drop shoes once it is really healed? Not today, but like when it is really, really healed and it is stronger and all that kind of stuff.” I said, “You can do whatever you want. You just have to be willing to pay the consequences.”

What I mean by that is that the plantar plate ligament, it is on the bottom of the foot, right underneath, usually underneath the second metatarsal phalangeal joint, that is just where the toe connects to the foot. So, you have the metatarsal bone, and you have the phalanges and where those connect, that is the metatarsal phalangeal joint, this little ligament on the bottom of it. It is a very small ligament.

When you stretch it out, when you injure it, when you get pain, when you get swelling and you do not treat it and it takes you like a year, a year and a half before you finally actually start fixing it, well, it is probably going to be stretched out even if it was not completely torn, because you have been bathing it in inflammatory fluid that actually degrades the collagen and makes it weaker over time. So, the problem is, is that you have got to decrease the stress and strain in that area. Make sense right?

So, there are two problems with that with zero drop shoes and I run in zero drop shoes occasionally. I do not run in them all the time. I use different shoes for different workouts. So, I am not one of those people that is a podiatrist who just beats up zero drop shoes and says everybody needs to be running in a standard running shoe. I do not believe that is true. But what I do believe is a zero drop shoes are a lot thinner than conventional running shoes. That is for sure. That means there is less cushioning between you and the ground. That is for sure.

What is also for sure a zero drop means there is no lift under the heel. Now, if you are a runner and you have any tightness in your Achilles tendon, if you have been in a fracture walking boot to treat the plantar plate injury, your Achilles tendon is going to be tighter. So, if you put a heel lift underneath the heel and you lift up, you decrease the tension on the Achilles tendon. If you have a tight Achilles tendon, and you remove that heel with zero drop shoes, you increase the force on the ball of foot because the Achilles is tighter and it is pulling more as it pushes down on the ground when your heels getting ready to come off the ground, what we call the mid stance phase of gait.

But when your heel is getting ready to come off the ground is the maximum amount of force underneath there. Some studies have shown that it takes about five times the amount of torque to get your ankle to end range of motion, right before your heel comes off the ground if you have been in a cast or fracture walking boot for six weeks or so. So, you do not want to do that. You do not want to have more pressure on there.

So, number one zero drop shoes are more issue with pressure from a tight Achilles tendon, a lot less padding and in most cases, they are very flexible. So, the flexibility in itself is not necessarily a problem but what I worry about when people with zero drop shoes when they have had a plantar plate and I have had one so I know what it is like. I know what it is like to be concerned about it and I worry about it probably more than you would because I think about them all the time.

If you have a plantar plate sprain and you are running in flexible, zero drop shoes, and you are changing direction on a trail or on a driveway cutout or you step on one of the reflectors on a crosswalk or something, it can tweak the foot with a lot more force because it is so much thinner. So, it is not that necessarily that just the zero drop is a problem. It is the inherent flexibility of those shoes that let your foot move a lot more without any protection and decreasing the amount of force of the dorsiflexion of the toes or movement of the toes that actually strings the plantar plate leg. That is what I would be concerned about. But if you love running in them, you can do whatever you want, just have to be prepared to pay the consequences.

If you liked this episode, please like it, please subscribe and if you haven’t seen it yet, if you have a plantar plate issue that you are worried about, come check out the plantar plate masterclass. It is a deep dive where I go into all the detail about all this stuff, the strategies that I use with plantar plate sprains and runners like this guy is talking about who signed up for a series of calls after about a year of not getting better and those strategies that I teach at medical conferences are what a teach you in the masterclass. It is free, you can get it at  www.docontherun.com/plantarplatemasterclass. So, come sign up and I’ll see you in the training.