Today on the Doc On The Run Podcast, we’re talking a little bit more about compressive stress on the plantar plate ligament in runners.
I recently posted an episode that was talking about four different kinds of stress and strain that can be applied to the plantar plate ligament that might slow down the healing of that little bitty ligament in runners. I got a couple of questions about that and one of them was specifically about how to tell whether or not that is really a problem and one person wanted to know if they had a dropped metatarsal if that might be contributing to this issue of compressive stress. I want to just talk a little bit more about that in this episode.
One of the things you have to think about again is that when you are doing anything that irritates the plantar plate ligament, it is bad. So, if you feel pain, soreness, achiness, weirdness, whatever you feel that signals that you are putting pressure on that ligament, it is probably going to slow down the healing because it is trying to heal. If you have an incision on the bottom of your foot and we sew it together we want it to heal, on the bottom of the foot we leave the stitches in for three weeks as a sort of broad rule.
If you had stitches on your arm or on the top of your foot they would only be in for two weeks but because you are stepping on it, it is a lot harder to get it to heal and there’s a lot higher risk it is going to come apart because you are compressing it, and it is pushing that healing skin apart, even if stitches are holding it there. So, when you have not sewn up the plantar plate ligament, you are trying to get it to heal you have to be really careful with it.
You do not want to have a delay in the healing of the plantar plate ligament particularly if you are a runner because even if you don’t really delay it, they can go on a really long time. I have had one myself, I know. So, this question came from somebody in the injured runners aid station and what they wanted to know was about a dropped metatarsal.
Sometimes I think people are told they have a dropped metatarsal and they don’t really know if it is a dropped metatarsal or not. I remember one time a chiropractor felt the back of my neck and he said oh you have a whole lot of arthritis in there. I probably do. I was very curious how he could feel that just touching my skin and I’m not so sure that he was exactly right. However, I kind of wonder about this dropped metatarsal thing too.
Dropped means that it changed position. If you look at the angle of the metatarsals from the side, then assuming one of them dropped down that would be that it changed position and went closer to the ground. Well, if it is closer to the ground and the others are further up from the ground on your second metatarsal and that is where the plantar plate’s hitting the ground it is going to apply more force to the plantar plate ligament for sure.
If you are told you have a dropped metatarsal number one ask the doctor how they know that. Question them. If they get upset about that, you got the wrong doctor. Just make sure you find out why they really believe that. What evidence do they have that it is truly a dropped metatarsal and is there something you should do about it.
The second thing is look at your shoes. If you have Birkenstocks or you have shoes that have some sort of material like Berko cork that actually gradually deforms over time you will see a bigger depression where your second metatarsal head is at the base of the second toe if you have a metatarsal that actually does have more pressure applied to it.
You can also look for increased calluses there because sometimes not just sheer forces and friction but sometimes just the pressure of that metatarsal bone poking down more causes thicker skin underneath it. So, that is what you are looking for if you have some concern that you’ve got a dropped metatarsal, or you have too much compressive forces on the metatarsal and the plantar plate specifically. You want to reduce that if you want to get to heal as quickly as possible.
If you want to check out the strategies that I teach to runners when they have these kind of injuries, what I teach the doctors at conferences. Just last week I was lecturing on this topic at the International Foot and Ankle Foundation meeting at the Swedish MedicalCenter and I share all those exact strategies with you in the Plantar Plate Masterclass. You can get it for free at www.docontherun.com/plantarplatemasterclass. So, go check it out and I’ll see you in the training.
«« #898 Fat Pad Displacement vs. Atrophy in runners with plantar plate injury | #900 How to calculate amount of rest between running injury and a race »» |