Today on the Doc on the Run podcast, we’re talking about how hyper extension can lead to a plantar plate injury.
If you are a runner, and you have pain in the ball of the foot, and you have self-diagnosed or been diagnosed with a plantar plate sprain, you probably already realize you are in for a lot of trouble. It is very difficult to get these things to heal, and it is even more difficult to get the plantar plate ligament to heal while you are still running.
Well, because of that, if you caused the plantar plate injury by hyperextending the toe, then obviously, if you want to get it to heal and continue running, you need to stop hyperextending the plantar plate by stretching it and pulling on it. And so, we are going to talk about why that happens. What we are talking about here is the plantar plate ligament is typically on the bottom of the second toes, the one that get injured and by hyperextension, we mean pulling the toe up way too much. That’s what we’re talking about, is pulling the toe up, dorsiflexing the toe, and we say hyperextension, it is pulling it up like this.
How does this happen? Well, it happens a couple of ways. The most common way this happens, obviously, your toe’s not going to get pulled up like this while you are running, but your toe does get in this position when you are doing lunges, when you are doing planks, when you are doing push-ups, when you are doing certain yoga poses that force the toes upward and really hyperextend those toes and cause a lot of trouble or doing elliptical trainers or running on treadmills with it really, really steep, particularly in flexible shoes, can also do that.
What happens though is that the reason this actually gets injured when you hyperextend the toe, when you pull it up in that direction over and over and over, is you are just stretching it way too far. If you stretch it way too far, and then you are doing an exercise that does stretch it, and you get weaker and you wobble when you are in that position, well, then that wobbling while you are holding the toe up can actually tear the plantar plate ligament.
When you do it chronically over and over and over, it is complicated by the fact that you get inflammation in and around the plantar plate ligament that has degradative enzymes that weaken the collagen in the plantar plate ligament. So then not only are you putting it in a position where it can tear, you have created a situation that makes it weaker because of that inflammatory fluid that’s been sitting around there because it has been aching for weeks or months, because you are just ignoring it.
You don’t want to ignore the pain, you don’t want to ignore the discomfort, and you do not want to keep doing exercises that force your toes all the way to the end range of motion because you are really stretching the plantar plate ligament, you are making it more difficult to heal, and putting yourself at risk for making the plantar plate rupture worse.
If you want to learn more about plantar plate strategies that I use with runners and what I teach to physicians at medical conferences when I go lecture on running injuries, well, you can join me and get a deep dive into those strategies specifically in the Plantar Plate Masterclass for Runners. You can get it for free at www.docontherun.com/plantarplatemasterclass. So, go sign up and I’ll see you in the training.
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