Can a percutaneous tenotomy surgery cause a plantar plate injury? Well, good question and that is what we’re talking about today on the Doc On The Run Podcast.
I often get some questions that I never would have imagined you guys might think of, but I did get one from a runner who has a thing called a mallet toe. The doctor had suggested doing a surgery for her and she was worried because she had looked at hammer toes and mallet toes and done all these searches for different conditions.
Since she has a mallet toe, which is kind of like a hammer toe, she was worried that if she had the surgery, it might cause a plantar plate injury. But I am going to explain to you why she’s concerned and whether or not that might really be a problem.
A mallet toe is where you have a contracture in the toe, not where the toe connects to the foot right here, this is the metatarsal phalangeal joint, but the contracture for a mallet toe happens out here at the distal interphalangeal joint, that is way out here. So, the tissues basically, the tendon that comes out and attaches to the end of the toe right here is got way too much pressure on it.
Now, you have the joint capsule, plantar plates down here. You have this tendon, the tendon goes right by the plantar plate, comes all the way out here and attaches to the base of the toe. The surgery for a mallet toe that the doctor is talking about is where we go in through the skin right here and we cut that tendon and then release it so that the toe will get released and go straight again.
But the incision in the skin is way out here. It is not back here. So, your two joints’ away from the plantar plate. The plantar plate attaches to the base of the proximal phalanx bone. That is the proximal phalanx bone where the plantar plate attaches. So, it attaches to the metatarsal and the proximal phalanx bone. Then you have the intermediate phalanx bone. The tendon that is being released when you have a mallet toe though is all the way out at the distal phalanx bone.
Since you’re doing surgery way out there, it’s really far away from the plantar plate and unless your surgeon is doing surgery with a weed eater, there’s no way that the doctor is going to mess up and injure your plantar plate when doing this surgery.
I like to say it’s an anatomic impossibility. It’s not going to happen. You’re not even in the same neighborhood. So, if your doctor’s telling you that you might need surgery for a mallet toe, you want to discuss all the risks and potential benefits of that surgery with your doctor, but you should not have to fear that you’re going to get a plantar plate injury. It shouldn’t happen at all.
If you want to learn more about plantar plate injuries and the strategies I use with runners who have those injuries and want to get back to training, running and working out more, I can share with you for free the plantar plate masterclass, which you can get at www.docontherun.com/plantarplatemasterclass. And we’ll do a deep dive into the strategies you should use, and you should discuss with your doctor if you really want to understand how to get back to running as quickly as possible. So, come check it out and I’ll see you in the training.
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