Tuesday, February 9, 2016

Plantar Plate Injuries

I wrote this post to share a bit about my injury, but first I have to tell you some exciting news. 

My new Doc freakin' rocks :) 
 Dr. Lane

Dr. Lane is a very accomplished athlete. He was very compassionate, hospitable, attentive, and thorough...I couldn't ask for more. I spent a good hour with the Doc today. 
Amazing. 

He thinks if I can be patient and heal, I have plenty of good years left in me. He wants me to wait till the end of the month before I try to run. He took molds of my feet today. I am going to try the orthodics. I have a very high ball of the foot area (naturally) and it absorbs too much impact, so the orthodics will be built up on the sides to take some pressure off that area, and hopefully make me run happy! 
He does want me to slowly build mileage if my feet respond well to running again. He said I have skinny feet, not much padding to absorb impact. Figures...everything else on me has an abundance of padding! 

I had never really heard of a plantar plate injury before I was diagnosed by my previous podiatrist on January 20, 2016. 
The previous doc was so negative about my prognosis, I refused to ever go back, but his diagnosis was correct.  

The plantar plate is a large ligament that runs under the ball of your foot and helps hold your toes in place. A extremely basic explanation of a complex structure. 

Here is a real definition: 
A plantar plate is a thick fibrocartilaginous or ligamentous structure. In the foot, plantar plates connect each of the metatarsals to the corresponding proximal phalange of each toe.
Plantar plate image
Plantar plates have a key role in stabilizing the metatarsophalangeal (MTP) joints

Tears of the plantar plate may be the most common cause of pain under the second metatarsophalangeal joint, though it can occur at any of the metatarsophalangeal joints.  It is also referred to as predislocation syndrome, crossover toe deformity and floating toe syndrome.  
Quote cred

and one more: 


Plantar Plate Tear

Most commonly experienced by middle aged women whose feet have a tendency to overpronate or roll in, a plantar plate tear is often a cause of persistent pain and swelling in the ball of the foot. It is also commonly associated with a bunion and a hammer toe. The plantar plate is a thick ligament type structure with attachments which inserts into the base of our phalanges (toe bones) in the area of the ball of the foot. The plantar plate is designed to protect the head of the metatarsal from pressure and prevent over extension of our toes. It also plays a role in preventing our toes from spreading or splaying.

Symptoms
pain and burning in the ball of foot 
sharper pain toward the metatarsal head 
Sensation of bone hitting the ground during a normal stride


Info Credit: myfootdr.com


My new Doc seemed impressed with my taping skills (thanks Google), and told me to continue doing that, but he did warn me my toes may never heal quite right. 
One of  my sloppier tape jobs


A synopsis of how I got to this state:

October: 
  • I had an issue with the bottom of my feet burning on a few longer runs. Usually 8 or more miles. 
  • After the run I would feel fine. 
  • 10 mile run (half marathon training) -  I felt a pebble sensation just under the ball of foot. I actually stopped running and looked to see if there was a rock stuck in my tread because it felt so specific (no rock). Rested almost a week. 
  • 11 mile run - felt better, foot burned just a little toward the end of the run

November: 
  • November 7th - started out to do six miles and only made it to four. I had burning, my arch seized up, I was in pain. I rested until the race. 
  • November 14th - ran the half marathon and felt great 
  • November 21st - my first run after the race (left foot felt tender)
  • November 26th - my next run, 5 miles (felt okay) 
I tried to rest, but it was't enough. 


December: 
  • December 6th - half marathon felt okay 
  • most of the month my foot would feel tender after runs
  • had some varying PF type symptoms

January: 
  • January 8th - toe cramps and burning under the ball of my left foot, and it felt like bone to pavement toward the end of my run that day. 
  • Foot swelled up like a balloon as soon as I took a shower. 
  • I noticed my toes were completely out of whack. 

I thought I had a stress fracture.  
The reality, I had a plantar plate injury. 

After x-rays  I could see the bones were in tact, but look like they are floating around in there, not sitting nice and straight as they should be. The tissue and ligaments are stretched, torn, damaged, I can't remember exactly what word the Doc used...


Just stay together toes! 
It seems really strange to me I didn't notice my toes going out of whack.  I feel like life at a 100 miles an hour is partly to blame. 
Always rushing to get out the door and run in the a.m., then rushing to shower to get to work, and rushing after work to get my gym work in, then rushing because I am hungry...relate, anyone? 
Seriously though, what genius misses their toes are crooked. That'd be me. 


  • Initially, after being off my feet a few days, the pain and tenderness increased under the ball of the foot. I could not put weight on it, or push off the ball of the foot with a normal stride.  
  • My foot stayed swollen for a little over two weeks.
  • Thirty days later, the tenderness is still enough to keep me from being able to plant and push off the ball of the foot bare-footed. When I have shoes or slippers on I feel better. 
  • If I shift my weight right, I get an intense cramp between toes two and three right at the base of the V. 
  • There is a large knot under the left ball of the foot. 
ugh...crooked toes after a month of healing

I was taping my right foot, because there was a slight separation between toe two and three, but the Doc told me today I could stop taping it. He showed me some toe yoga he wants me to do, and it is more challenging than one would think! 

I am so relived I have a Doctor that actually wants to help me now. He told me any activity that didn't hurt was fine, but to be careful not tweak my foot or the "time off" clock would start over. I will be living in my running shoes until I am well. Tissue is slow to heal (three to four months), but it will heal, and he wants to see me enjoying running again. 


Are you familiar with plantar plate injuries? 
Have you ever experienced a drifting toe, or known someone with this aliment? 
Ever had the ball of your foot swell to twice its size? 

36 comments:

  1. I don't think I had ever heard of this injury until you. and I am so happy for you to have found a doctor that is understanding, hopeful and willing to talk about how to get you back to running. What a great guy! I hate when the answer is "no running ever again" HA! Nope, new doctor!

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    1. Thank you Christy :) I was so relieved that this appointment went so much smoother. It helps to have a Doc passionate about fitness for sure :)

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  2. Very good news! I am sure you are so relieved and have a plan to get back to running.I love having a team of specialists that want to keep you back in the game. I have my sports doc, my PT and the radiologist that has done 4 injections for me. All are super supportive of my running and help me tremendously. And also my husband--can't forget how much Rick does to support me. Looking forward to hearing more about your great progress!

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    1. I am so relived! I slept well for the first time last night in several days. It is good to have a supportive team.
      I am glad you have been able to stay healthy and keep running. I am not sure what my running will look like when I can get out again, but I suspect I will be have to be a little more conservative to stay healthy.
      Thank you :)

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  3. I am SOOO happy you got in with this doctor & he's giving you HOPE!!!! YES!!!

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    1. Thank you :) I felt so much better when I left his office yesterday.

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  4. I am so happy you have a doctor who was thorough in his examination and didn't give up on you!!! It sounds like he is being realistic while still having the ultimate goal of getting you back out on the road.

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    1. It was a much better experience! I hope I can return to some regular weekly running next month...we'll see.

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  5. Yay, this is great news! He sounds like a perfect fit :) And it's great that you have a plan going forward to heal but also be able to run again.

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    1. Thank you Chaitali :) I slept so good last night! Finally :)

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  6. I've never heard of a plantar plate injury. I'm so wrapped up in my plantar fasciitis that I didn't know there was anything else. Sounds like you are in good hands. Sorry that this happened to you!

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    1. When I was having symptoms leading up to this some fit stress fracture and some PF, but never quite right. The lady at work who is in a similar situation doesn't even exercise much, so apparently this can happen to you even if you don't run, but my running on it made it worse for sure. I am in good hands, thanks Wendy :)

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  7. I've not heard of this either but I do have friends who struggle because that fat pad in the foot has thinned. Maybe this is an escalation of that?? Anyway I'm glad to hear you have a good doc taking care of you and the prognosis is good! Hang in there!

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    1. Yes, the padding is very thin under the bottom of my foot and that does happen to some as we age. he explained my foot structure and showed me how when I hit the load isn't distributed well. I sure hope the orthodics help. Sometimes because the toes will never be right they hinder people from running, but I hope I can get beat that. II have found a few folks online who have come back and run after this type of injury, so I feel I will get there! Thank Marcia :)

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  8. Yay for the new doc and the good prognosis! Taking time off and easing back in is a BRILLIANT plan!

    Thanks for the pics of the plantar plate! That really helps me visualize it. And isn't it great to have blogged/logged what is going on so you have all these great notes to share with the doc and us?!

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    1. It was like night and day between the doctors! I feel so fortunate to have found this one.
      You know I want to run all my races I had planned, but as each day passes I realize I probably won't be able to jump back in to long distances. It is hard to let that go, but it would probably do me well to baby this foot and keep the mileage down.
      I know I was able to give him dates and all kind of info, he smiled that I was a running junky lol

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  9. Never heard of this injury before. So glad you found another Dr and I agrew, he sound amazing. Just keep following his advice. I'll keep praying for good news.

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    1. It is not commonly out there in the runners book of injuries is it...
      I think Doc was the first answer to prayer :) and I appreciate it. I am going to try to not jump back in full force when the time comes, and do what he suggests :)

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  10. You have been doing great research on this. I do hate that you are having to go through it but if you can help someone else with this that would make it a little better.
    Question: How can you even concentrate on what Dr Looks good says???? Just saying... Have great week Karen! :)

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    1. Thank you Tricia, I am putting it out because who knows, maybe it will help someone. That pebble sensation can lead to bigger issues, it is good to be aware.
      Well, I was concentrating hard on what the Doc was saying lol and my hubby came back with me (and I only have eyes ;) for him), because he wanted to hear what the Doc said so I didn't try to scam him later LOL he knows me...but Doc is quite the athlete.

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  11. So sorry to hear that you are still going through this injury. I have never heard of it. I have only heard of plantar faciatis. Glad you found a great Dr to help you.

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    1. Thank you, I find a lot of folks have not heard of it and I hope you never need this info :) I am very happy with my Doc.

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  12. So happy you found another doctor who took the time to listen and problem solve. Be patient ! I can still remember a time when I couldn't run any further than 5K without being in excrutiating knee pain. Orthodics + proper diagnosis + rest has paid off ! It took a while for me to come back and I might sound like a broken record but the run/walk method is doing wonders not only for my body but for my ego. I actually don't care that I don't run non stop now. I prefer to keep on run/walking long distances than only run short distances.

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    1. I hope the orthodics help me. I can manage my toes by taping them, they are never going to heal completely right now, it has been too long, but I can not do anything about the tissue on the bottom of foot, I hope the orthodics are enough cushion! I think they will make the difference whether I can handle long distance or not. I will use the run /walk for any distance runs I try, we actually talked about it and he wants me to stick with very short runs, but said that was a good way to tackle the days I want be out longer :) I think when I can finally get out there i won't care that I am "walking" for my runs lol It is great it works for you! Gives me hope.

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  13. First, it is awesome that you found such a great doctor! That said, I'm sorry you are dealing with this, but I really appreciate the information. I hadn't heard of this injury, but will watch for early warning signs.

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    1. Thank you Coco. That pebble sensation is a big one. I have read many accounts where that is what people would initially feel. It is always good to have a little knowledge tucked away :)

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  14. So sorry to hear this. My dad is going through this same thing, he started having problems last June. He gets discouraged but although everyone is different his specialist is very positive. Some heal in months, others years, but if you do the right things, and put the time into healing then even though it may not happen as soon as you want, it will happen!
    Glad you found a doctor who seems like he believes in you too!
    3 years ago I got achillies tendonitis and then peroneal tendonitis from working too much on my feet in the wrong shoes. It's been a battle, and at times it feels like it will never heal. But even though it's been years, the doctors have led me correctly and I do see an end in sight. I only share that, so you know I totally understand a bit of what you're going through
    Just keep doing the right things, and you'll get that running back, I know it!

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    1. Awww, your Dad has the crooked toe? :( I have seen worse cases where the toes really dislodge and lift high and that seems to be where a lot of people can't maintain activity, you are always in pain.
      It scare me how long tissue can take to fully heal. There isn't a thing you can do to rush it though...
      Do you wear othodics now? I can't remember if you told me that. Doesn't it amaze you how long things can flare up even though you try to make the correct changes?
      I know you have dealt with your fair share of challenges and certainly you deserve some relief, I know you understand. I appreciate your encouragement :)

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  15. Whoa! Sounds painful! But your toes still look cuter than my toes! haha!

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  16. I am so glad you finally have a diagnosis and know what to do and what to expect as your foot heals. I hope your custom orthotics help you as much as mine have helped me. I also hope your insurance will kick in and help pay a portion of the cost. My paid zero, yet they were willing to pay for months of PT that unfortunately didn't help.

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    1. Thank you so much :) I am very glad to hear your inserts have helped you! I don't think mine will be covered, but if they work it will be totally worth it :) Since I have tissue damage he said PT will be unproductive, he gave me some toe yoga to do. Most Docs want to send you to PT it seems...I feel blessed to have someone who wants to help be as active as possible.

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  17. I am so glad that you have an answer--and that you are working towards a solution!! That is GREAT news. It helps so much to have a doctor who relates to athletes!!

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    1. Thank you Cheryl :) It made a huge difference because he understands how much I need my running and walking. He gave me lots of hope I can make a comeback. He explained I will never be like I was, but he was so much more encouraging than the other Doc, it was like night and day :)

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  19. Oh how I wish I had seen your blog post last year!! I have / had the same injury last April. I had to have surgery in July (successful), but not the 2nd toe is having the same issue! Are you "fully" recovered?

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