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Running Injuries Plantar Plate Sprains and Plantar Plate Tears

Plantar Plate Sprains and Plantar Plate Tears

What Are Plantar Plate Sprains?

Plantar Plate sprains are a common disorder that affects runners of all ages and run all distances.  Runners will typically describe intense pain near their 2nd through 4th toes in the ball of the foot that gets worse while walking or running. Read on for more information, or see our Plantar Plate Sprain Overview.

Video on Plantar Plate Sprains – 3 Minutes

Typical Plantar Plate Sprain Scenario

A typical scenario that occurs will be for the runner to ask their running buddies what to do about the pain.  Frequently they are given advice that leads them down a path of frustration and more pain.  They try icing their foot and taking Ibuprofen most commonly.  Sometimes the runner consults their primary care doctor who simply tells them to stop running or may refer them to a foot specialist.  Once at the foot specialist they may receive one of many incorrect diagnosis.

Common Plantar Plate Sprain Misdiagnoses

Plantar plate sprains and tears are often misdiagnosed. Compare similar running injuries and conditions, plus learn how to differentiate between each.

Morton’s Neuroma

The most common misdiagnosis is Morton’s Neuroma.  This condition is confused with a Plantar Plate sprain because both injuries can result in burning pain that shoots into the affected toes.  If this incorrect diagnosis is given the specialist may inject the area with cortisone with little to no affect.  Differentiating these conditions is actually quite simple with proper manual, orthopedic testing.  If there is still doubt after a thorough examination an MRI can be used to differentiate the disorders.  San Diego Running Institute has brokered cash deals with private, local San Diego MRI facilities for those that have either no MRI coverage or catastrophic deductibles that often prevent them from obtaining proper care or treatment.  The average cash fee for an MRI is only $400.

Metatarsal Stress Fracture

Another common misdiagnosis is a Metatarsal Stress Fracture.  While Metatarsal Stress Fractures do occur they are over diagnosed.  Metatarsal Stress Fractures are confused with Plantar Plate sprains because the Metatarsal bone can fracture at the Metatarsal Neck which is close to the Plantar Plate.  In addition both injuries can cause the person to limp even when not running.  These two injuries can usually be differentiated with a proper and thorough orthopedic exam.  If there is still doubt as to the true nature of the injury an X-ray or MRI can be used to provide a complete and accurate diagnosis.

X-rays can be performed the same day as the examination and do not require a scheduled appointment whereas an MRI can usually be performed within a couple of days.

Sesamoiditis

Sesamoiditis is another condition I have seen diagnosed incorrectly over a Plantar Plate sprain.  Sesamoiditis is a painful condition that affects the Sesamoid bones found under the First Metatarsal.  This condition is easily and quickly differentiated from a Plantar Plate sprain due to where it is anatomically located.

Interdigital Bursitis

I have also seen Interdigital Bursitis misdiagnosed as a Plantar Plate sprain.  This painful condition is characterized by pain found between the Metatarsal bones instead of beneath the Metatarsal bones.  During a proper orthopedic examination this condition is identified by pressing the softer region between the Metatarsal bones.  If localized pain is present you may be suffering from Interdigital Bursitis.

Frequently Asked Questions (FAQs): Plantar Plate Sprains

Here are my answers to questions that patients often ask about plantar plate sprains. If you would like to make an appointment call (858) 268-8525.

What Are Grade 1, Grade 2, & Grade 3 Plantar Plate Sprains?

A sprain is a torn ligament.  Sprains occur in varying degrees of severity.  A Grade 1 Sprain describes a ligament that was overstretched which results in microtears and ligament laxity.  A Grade 2 Sprain is defined by partial tearing of the ligament resulting in more severe pain and possibly, partial joint deformity.  A Grade 3 Sprain is a complete tear of the ligament and results in intense pain with obvious joint deformity.  Since Plantar Plate Sprains come in varying degrees they are sometimes difficult for doctors who do not specialize in diagnosis and treatment of the disorder to identify and diagnose accurately.

How Do I Know if I Have a Torn Plantar Plate?

If you have pain beneath your 2nd, 3rd or 4th metatarsal that gets worse with walking, jumping or running you may have a Plantar Plate Sprain.  In the early stages of the injury it is most likely a Grade 1 Plantar Plate Sprain and can be treated quickly and effectively with conservative methods.  You will know if the injury has progressed if your pain gets worse or you develop a limp following activity.  Dr. Runco and the San Diego Running Institute can perform a thorough orthopedic examination of your foot to accurately diagnose the condition and differentiate it from other conditions such as Metatarsalgia, Metatarsal Stress fracture, Interdigital Bursitis, Morton’s Neuroma and Sesamoiditis.

How Do I Fix My Torn/Sprained Plantar Plate Ligament?

Depending on the severity of the tear depends on the course of treatment that will be effective. Some common treatment suggestions include:

  • Stop running until it heals
  • Plantar plate supports on insoles of shoes
  • Waterproof athletic tape
  • Therapeutic Ultrasound
  • Simple exercise
  • Stiff bottom walking boot
  • Surgery (last resort!)

Grade 1 and Grade 2 Plantar Plate Sprains are treated with excellent outcomes at the San Diego Running Institute.  Grade 3 Plantar Plate Sprains are more severe and will not typically respond to conservative treatment and may require surgery.  While I never desire to tell a runner to “Stop running”, that is exactly what I have to do in most cases of a Plantar Plate Sprain.

In mild cases we successfully treat the condition by placing Plantar Plate supports on the runner’s insoles of the shoes they wear most often.  We also use waterproof athletic tape to align the joint to ensure maximum and effective healing.  Therapeutic Ultrasound is applied to stimulate blood flow into the largely avasucular Plantar Plate Ligament.  Simple exercises are prescribed to stimulate blood flow and promote strengthening of the deep intrinsic muscles of the foot.

Severe Grade 1 sprains and Grade 2 Plantar Plate Sprains usually require me to prescribe a stiff bottom walking boot for the runner to wear for six to twelve weeks depending on the severity of the sprain.  This ensures that the patient is not flexing, bending or stretching the damaged Plantar Plate and allows for maximum and complete healing.  During the time period the patient is required to wear the boot a therapeutic protocol consisting of Ultrasound, taping and exercises is also undertaken.

Do I Need Plantar Plate Surgery?

Only after failing conservative therapy should surgery be considered.  While surgery is an option is should be your last resort in most cases.  It is my experience that 90% of patients I treat with conservative methods do not require surgery and return to normal, pain free running.

Do I Need Custom Orthotics For My Torn Plantar Plate?

While custom orthotics are a common intervention in the treatment of Plantar Plate Sprains they are not a panacea.  If the custom orthotic is not crafted correctly, if the plantar plate support is not placed precisely and if the injury is not addressed and given time to begin the healing process than the custom orthotic will most likely be ineffective.  It is my experience that after the injury is healed and the person resumes normal pain free activity a custom orthotic can be made to prevent future reoccurrences of the injury.  San Diego Running Institute makes our own custom orthotics on site which helps keep the costs below average ($247) and gives us complete control in the construction of the orthotic.  It has been my experience in the past that orthotic labs create hard, rigid orthotics that actually make the condition worse.

Will My Plantar Plate Tear Heal 100%?

If all of the correct procedures are followed there is no reason to expect anything less than 100% resolution of the condition.  By supporting and/or immobilizing the Plantar Plate, usually for a period of 6 weeks to 3 months, the ligament will heal by forming new tissue know as Fibrin.  The new fibrotic tissue will essentially from a “patch” over the damaged area of the Plantar Plate.  This new fibrotic tissue will at first be stiffer and may result in feelings of “tightness” beneath the Metatarsals.  Over the period of the next few months, even up to a year, the feelings of stiffness and tightness will lessen due to specialized cells in your body called Macrophages.  These cells will reshape and reorganize the fibrotic tissue molding it as close to perfect as possible.   It is my experience that making custom insoles with Plantar Plate supports provides additional protection to the area while it undergoes remodeling and strengthening and are a viable addition in the prevention of future reoccurrences.

My Personal Experience as a Marathon Runner with a Sprained Plantar Plate

As a competitive Ultra Marathon runner I understand the importance and significance of running.  It is our “yoga”.  I completely understand how a runner can rationalize running with a painful condition such as a Sprained Plantar Plate.  I know because I did it.  I ran with a painful and sore 2nd metatarsal for months.  The injury did not appear to be worsening so I continued to run on it until one day it went from bad to worse…..in an instant.  That day it progressed from a Grade 1 Sprain to a Grade 2 Sprain/tear.  The pain was intense and caused me to limp.  An MRI confirmed the extent of the tear.  I ended up in a walking boot for almost 3 months as well as receiving Ultrasound therapy every other day in my own clinic.  After five months I was back to running significant distance and at month eleven I ran a 50K, setting a personal best.  Because I suffered from this injury I have empathy for those that suffer from it and have developed a deep passion for helping others correct it in addition to becoming an expert in the treatment of it.

Be sure to read the comments for patient questions and my personalized responses about plantar plate sprains, tears, and injuries.

Dr. Runco

About Victor Runco

Dr. Runco is a U.S. Navy and Gulf War Veteran. He began private practice in 2000 primarily treating and fixing running injuries. He has been a professor of Anatomy, Physiology, and Biomechanics at various colleges and continues to teach continuing education in the fields of rehabilitation, custom orthotics and athletic taping. He is also a member of the American College of Sports Medicine, National Strength and Conditioning Association and is a Certified Strength and Conditioning Specialist. He has completed over 15 Marathons in 15 states and has run 11 50 mile Ultramarathons.

Comments

John 05-01-2013, 14:06

I am a long distance runner myself and just stubbed my toe last month. After an unremarkable x-ray I decided to do a pod. She diagnosed me with a mild Plantar Plate Sprain. It feels like I have a ball in the ball of my foot at the second toe. Doctor feels that keeping it taped for 3 weeks will most likely provide me with a favorable healing outcome. Running has been put on hold…BUMMER and going insane because running keeps me sane.

Dr. Runco
Dr. Runco 05-01-2013, 20:40

Hi John,
Sorry to hear about your troubles. From the limited information you gave me I am going to ASS UME that the podiatrist is correct, although I know a true plantar plate sprain can only be diagnosed and confirmed by MRI. Your podiatrist may also be undermining your problem by minimizing it. A sprain is equivlant to a tear. Sprain come in 3 degrees of seriousness. Grade one tears are minor with no joint deformity and can take from 3-6 weeks to heal….if you do not aggravate it. Grade 2 sprains are partial tears and result in mild joint deformity. Grade 3 tears are ruptures and result in obvious joint deformity. Whatever the case plantar plate sprains are serious business…..especially for runners. I typically will place a metatarsal pad for my injured runners as well as instruct them how to tape their toe into plantar flexion. If the pain is not significantly reduced in this manner I put them in a walking boot for 6 weeks. As much as i hate to do this I have learned from 13 years of experience treating this condition that it can go from bad to worse in an instant. That means it can progress from a grade 1 to a grade 2 in an instant. This translates to instead of 6 weeks in a walking boot possibly 3 months and possible surgery. If you want my help John simply follow the directions below.

Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $67 (normally a cost of $125) and by calling my office at 619-265-2222 ext. 2 after 12 noon Pacific Time today, Brittaney can schedule a 45 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know. Example: How you had an X-ray
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

theresa murdock md 11-01-2013, 19:52

I also have been having pain at my 2nd metatarsal area, since Oct. First went to a sports doctor told arthritis thee to a sports Chiropractic who thought it was interesting how my 2nd toe was beginning to medially deviate, he manipulated my foot.. Finally to podiatrist who in 1q sec told me I had a tear. I used to run daily but too painful walking the dogs at mile 2 becomes a limp. Any suggestions would you go straight to surgery or conservative measures

Dr. Runco
Dr. Runco 14-01-2013, 21:28

Did you have an MRI? If the tear is partial you do not need surgery necessarily. Surgery should be your last resort. There are many techniques to treat plantar plate tears that are effective and conservative. When I partially tore my 2nd plantar plate I was able to avoid surgery and am back to 50-60 mile running weeks. if you would like my help and guidance in fixing your problem without surgery please follow the directions below.
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $67 (normally a cost of $125) and by calling my office at 619-265-2222 ext. 2 after 12 noon Pacific Time today, Brittaney can schedule a 45 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know. Example: How your toe deviates medially
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

JoAnn 08-02-2013, 02:10

Hi Dr.
What do you consider partial joint deformity that characterizes a 2nd degree tear? My 3rd toe on my right foot shifts slightly to the right. Leaving a V between my 2nd and 3rd toes. My 2nd toe just barely lifts. Is that considered a deformity associated with a 2nd tear? Or is that a sign of a more substantial deformity. I have a walking boot and I’m on day 4 of it. Would you recommend I tape my toes together?
Thank you!
JoAnn

Dr. Runco
Dr. Runco 08-02-2013, 04:23

That is a definite joint deformity. You need to not only tape them together but the involved toe needs to be taped into plnatarflexion. You are looking at most likely 3 months in the boot

Dr. Runco
Dr. Runco 08-02-2013, 04:23

That is a definite joint deformity. You need to not only tape them together but the involved toe needs to be taped into plantarflexion. You are looking at most likely 3 months in the boot

Kate 05-03-2013, 23:06

Dear Dr Runco,

My bizzare injury came about whilst I was foam rolling my ITB several weeks ago. I was on my left side when there was an almighty crack across the metatarsals in my supporting right foot as my weight shifted. For the days after there was some pain in the ball of my foot and slight tinging/burning sensation intermittently but nothing that made me worry. About a week and a half later the pain became a lot worse with sharp/burning pain on the underside of my foot centred on the 3rd/4th metatarsals on weight bearing which intensifies the further I walk etc. There is tenderness over the 3rd and 4th heads on the dorsal surface too. There is some discomfort on toe flexion and my toes have adopted a somewhat extended position at rest. I could convince myself that there is an increased gap between my 3rd and 4th toes. X ray was normal. I have been icing and cross-over taping the 2nd, 3rd and 4th toes and this has greatly eased weight bearing pain but quickly returns if I don’t use the tape. Do you think this is a likely plantar plate tear? Should I be doing/not doing anything else? Is using the recumbent bike and cross trainer at the gym okay if there is no exacerbation?

Any advice would be much appreciated! Many thanks!

Dr. Runco
Dr. Runco 06-03-2013, 04:24

Hi Kate,
I am sorry to hear about your plight…… I am an expert in this injury and would be happy to help you out. You provided me with an excellent history and you already have had an X-ray to confirm there are no breaks. The “crack” you heard must have been the ligament tearing. This injury needs to be diagnosed correctly and the proper steps taken or it could get much worse.
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $67 (normally a cost of $125) and by calling my office at 619-265-2222 ext. 2 after 12 noon Pacific Time today, Brittaney can schedule a 45 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Yvonne 07-03-2013, 14:13

Hi, Dr. Runco! I am still trying to sort out what I suspect is a plantar plate injury… I had a rather mild midfoot sprain in August of 2012, then ended up in a variety of walking boots for a few months, one of which caused other, totally different issues/pain in my foot. All the pain is now in the ball of my foot, and my second toe is rising slightly (I also have a mild bunion and very high arches). I also have some pain in my big toe, but it seems to just be tight or a little stiff, though I do have very good ROM still, strangely! I have seen a few docs, only one of which is an orthopedic surgeon, have had several cortisone shots (those have caused ongoing pain in bruising on the top of my foot, but I know that will eventually diminish), tried crutches back in December for a while, and am working with a great pedorthist to get the proper orthotics. I just had a CT scan yesterday (after many X-rays that don’t show any real bone damage), and an MRI back in October, but that was before the ball of foot pain/inflammation set in. The MRI showed bone marrow edema in several bones, including the 2nd and 3rd metatarsals as well as the cuneiform. I am seeing a new orthopedic doc in several weeks who is supposed to be highly recommended where I live, and is nearly impossible to get in to see. However, in the meantime, if I do have a plantar plate tear (even a micro-tear or sprain), would that show on a CT scan? I am not running (have not since the end of August), and am modifying EVERY exercise I do, focusing mainly on core, arm weights, and Pilates. The doc I saw a few weeks ago did NOT impress me. He told me to tape my second toe down and mentioned plantar plate, but would not diagnose anything–he basically blew me off. I realize plantar plate injuries can be difficult to diagnose, but this has been going on for months (granted, the original injury was quite different to what I’m experiencing now), and I’d like a few more answers so I know how to proceed. I am very active–and remain as active as I can be, even now–but am tired of wondering if I’ll ever feel comfortable walking long distances again, if I’ll ever be able to run again, etc. I have been using my rowing machine (only pushing through my heel, with a “braced” pedal, and mainly pushing with my good foot) at times, as I miss being able to use my machines. I guess I am just curious to know if it’s normal to have fairly constant pain/discomfort, if I have damaged my foot further by having multiple cortisone shots, and if ultrasound might help heal soft tissue damage–even if it does NOT turn out to be a plantar plate issue. As I said, my bones seem fine–no stress fractures, dislocations, or arthritis at this point. Thank you for anything you can offer!

Dr. Runco
Dr. Runco 07-03-2013, 16:01

Hi Yvonne,
I am sorry to hear about your plight…… I am an expert in this injury and would be happy to help you out. You provided me with an excellent history and you already have had an MRI to confirm the diagnosis so ignore most of the “template” paragraph below. To quickly answer some of your questions….multiple cortisone shots is never a good thing…never. Ultrasound will help soft tissue heal if done correctly. There are many other therapies I can advise you on that may be appropriate. You should call my office at 619-265-2222 so that I can counsel you on your condition and let you know about your options. Please fax your MRI report to 619-265-8233 before we have our phone consult. Stay positive, have hope and be optimistic Yvonne. This will be the best $67 you have spent Yvonne, I promise.
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $67 (normally a cost of $125) and by calling my office at 619-265-2222 ext. 2 after 12 noon Pacific Time today, Brittaney can schedule a 45 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

tina perilli 13-03-2013, 01:50

Hi Dr.Ronco,

Just wanted to see what you think about this…. I had a car accident in January 2013, thus slamming my right foot hard on the brake. It has been about 8 weeks and my right foot still hurts. It hurts underneath my foot, near the 2nd digit and is still a little swollen. Sometimes my 2nd toe feels like it is stuck for a short while and I have had a few foot cramps. I went to a Podiatrist and he took X-rays and ultrasound. He said there was a small tear on the planter plate. He said it could be fixed by surgery and there are other conservative measures that can be tried. He said the surgery would take 20-30 minutes and I would be in a boot for 4 weeks.

I want your opinion if you think it can heal by itself if I tape it and do whatever treatment is deemed? I really don’t want surgery, this will be my forth foot surgery. I had a ankle reconstructive surgery 5 years ago and two hammer toes surgeries 12 and 16 years ago. These surgeries were all on the right foot.

Thank you so much for your insight Doctor, I appreciate any and all advice.

God Bless you,

Tina Perilli

Debbie Ellis 07-05-2013, 09:38

I first experienced pain at about mile 11 in a half marathon. Didnt take too much notice of it but then over time I found driving very painful. Left foot – clutch pedal. Pushing on the pedal which forces the ball of my foot down and toes up left me in excruciating pain. This has been going on for nearly a year and I have noticed some deformity forming in that my second toe has begun to ‘hammer’ and my third toe is separating away from it. I also seem to have a crease below these toes which makes it look like my foot has dropped. I eventually had ultrasound (no Mortons neuroma), two visits to orthopaedic surgeon and eventually x-ray (within normal limits – just mild hallux valgus). Now going for MRI as my surgeon thinks I may have ruptured my plantar plate and having read your website, it exactly describes my symptoms. I am so frustrated I cannot run. Although I am now coming up to 55, I love running. While waiting for MRI do you think to stop driving manual car would help as that is the main irritant. I have tried everything to help myself. I live in running shoes. No high heels and have stopped running. I tried a walk yesterday and then 25 yard run and then could not hardly weight bear last night. I am prepared to try anything. Thank you. Unfortunately I live in the UK so obviously not practical to visit!

Dr. Runco
Dr. Runco 07-05-2013, 18:22

You have a torn/ruptured plantar plate. Stop driving the manual it is making it worse from the sound of it. Think of it like putting you hand over a hot stove….if it burns and you don’t move it it will only result in more damage. Stop irritating it at all costs. Get in a walking boot asap. Get the MRI result. If it is completely torn you will need surgery. If it is a partial tear you can try prolotherapy or PRP, tape the joint in the correct alignment and stay in the boot until it heals…2-4 months.

alison Mackenzie 18-05-2013, 22:23

Hi there I have been seeing a podietrist and its looking like I have a plantar plate tear, just waiting on an ultrasound. Unfortunately it is now 9 months after the initial injury. I already have some toe deformity (gap between 2nd and 3rd toes). Will conservative methods still work after this length of time or am I likely to be facing surgery?

Thanks very much x

Dr. Runco
Dr. Runco 20-05-2013, 14:59

Hi Alison,
I am sorry to hear about your foot condition. You most likely have/had a grade 1-2 Plantar Plate Tear. Does the pain occur if you stretch your toes all the way back. If you put maximal weight on them? Does it hurt at all when you run? Does it hurt at all after? Based on your description of how your foot looks (deformed) I suspect it can still be treated conservatively. I am an expert in this injury and would be happy to help you out. In fact, I had this injury myself 2 years ago and avoided surgery. You provided me with an excellent history and you already have had a legitimate diagnosis. You should call my office at 858-268-8525 so that I can counsel you on your condition and let you know about your options. Please fax your MRI or Ultrasound report before we have our phone consult. Stay positive, have hope and be optimistic Alison.
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $77 (normally a cost of $125) and by calling my office at858-268-8525 after 12 noon Pacific Time today, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Blue Serge Suit » Blog Archive » Injuries 05-06-2013, 03:12

[…] problem with my foot is a sprained/torn plantar plate. From what I can tell it’s not a very common running injury. It’s not a common injury […]

Dr. Runco
Dr. Runco 05-06-2013, 22:09

It is common enough that I see it on a weekly basis and suffered from one myself 2 years ago. There are many ways to fix them conservatively depending on the severity of the tear. Have you had an MRI? What kind of Doctor have you seen? What have you tried?

CC 10-07-2013, 13:30

I would like your opinion. Within the last 9 months I have been diagnosed with stress fracture in the 4th & 5th metatarsal, was put in a boot for 2 months. Two months later was still in pain in my 5th metatarsal and had a bone scan when resulted in a 3rd metatarsal stress fracture and was boot in a boot again for 1.5 months. Pain still wasn’t going away 5th metatarsal so I went to a different doctor, he told me it was just over use and told me to PT and stay off of it. I have pretty much haven’t done cardio since I was placed in the boot the 1st time so I wasn’t happy with that answer. All 3 doctors didn’t seem to believe me when I said I was having pain in my 5th. I went to a 3rd doctor and he did an MRI and I have a partial tear in my 5th metatarsal plate. I am supposed to stay off of it and I have custom orthodics for two months if not surgery will be need. I am going on vacation and so he said I could have a cortisone shot but I am wondering your opinion on that. Thanks

Dr. Runco
Dr. Runco 10-07-2013, 13:37

Hi CC,
I am sorry to hear about your plight…… I am an expert in this injury and would be happy to help you out. You provided me with an excellent history and you already have had an MRI to confirm the diagnosis so ignore most of the “template” paragraph below. There are many things you can do to avoid surgery but they have to be done asap and done correctly.You should call my office at 858-268-8525 so that I can counsel you on your condition and let you know about your options. I have treated and corrected this condition in hundreds of runners and non-runners from San Diego to New York to Florida. Please fax your MRI report to me before we have our phone consult. Stay positive, have hope and be optimistic CC. I believe that after discussing your situation with me you will feel more confident moving forward, be aware of all your options and be better able to choose a competent doctor.
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time tomorrow, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Nils H 16-07-2013, 19:27

Hi, I have been diagnosed with a capsulitis in both my 2nd toes (left and right), with a possible plantar plate injury on the left. I was diagnosed by a podiatrist in LA while travelling through on vacation (I live in Sweden), so no MRI yet. I will try to get that in Sweden. It has been going on for almost three months in my left and 3 weeks in my right. Right now I walk (very little) with two custom insoles with cut-outs for the metatarsal heads and a pad behind the head (towards the heel).

While fighting to get access to a good doctor in Sweden I am working on the best conservative self treatment, and hoping for some advise:

– Taping the toe into plantar flexion. Should it be done day and night? Flexible or unflexible tape?
– Walking boot – just go ahead and buy any stiff, unflexing walking boot that feels comfortable?

Many thanks in advance for any advise!
Nils

Dr. Runco
Dr. Runco 16-07-2013, 20:05

Hi Nils,
I am sorry to hear about your plight…… I am an expert in this injury and would be happy to help you out. You provided me with an excellent history and you already have begun to take steps in the porper direction. There are many things you can do to avoid surgery but they have to be done asap and done correctly.You should call my office at 858-268-8525 so that I can counsel you on your condition and let you know about your options. I have treated and corrected this condition in hundreds of runners and non-runners from San Diego to New York to Florida. Stay positive, have hope and be optimistic Nils. I believe that after discussing your situation with me you will feel more confident moving forward, be aware of all your options and be better able to choose a competent doctor in your area. Are you currently in PT? What else have you tried? How old are you Nils? Have you tried orthotics?
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time tomorrow, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Mac Watson 28-07-2013, 17:44

I was just diagnosed with a plantar plate tear by an orthopedic surgeon despite having a negative MRI. I have had discomfort for months but not really signficant pain per ‘se. Just a dull, nagging sensation as best as I can describe it. I’m wondering how the MRI missed this? The surgeon who examined me in his office said all indications looked like I had a “bad” tear although he never said what level – told me to wear a metatarsal pad and come back in 6 weeks for another check. No boot was recommended, yet he mentioned surgery (I have the classic “Morton’s toe as well). What are your thoughts about the negative MRI?

Dr. Runco
Dr. Runco 29-07-2013, 13:40

Hi MAC,
You could have;
1. Mortons Neuroma ( probably not as the MRI would usually show a neuroma and you do not describe neuroma symptoms)
2. Plantar Plate Sprain/Tear (most likely diagnosis even though the MRI seemed to have missed it)
3. Capsulitis (might be secondary to Plantar plate tear)
4. Metatarsalgia (it is possible you have bone marrow edema in your metatarsals)
5. Stress Fracture (not likel)
I am an expert in the diagnosis and treatment of these injuries Mac. I have seen hundreds if not thousands of runners misdiagnosed or under-diagnosed, told to get metatarsal pads or inserts by incompetent doctors, useless and needless surgeries for Grade I plantar plate sprains when in fact they could have taken conservative measures early on rather than waiting for the condition to worsen and eventually rupturing. Although the MRI did not show the tear your surgeon is most likely diagnosing you based on a process of elimination. The 5 diagnosis I provided at the top are the most likely causes. The MRI would almost certainly show stress fractures, bone marrow edema and neuroma’s. Because the surgeon did not see any of these he is diagnosing plantar plate sprain. I am saying it is probably a grade I because a grad II or III would be extremely obvious. There is also the possibility that either the surgeon or the radiologist that read the film missed it or that the MRI quality was too poor to see the small tear in the ligament. I have a personal history with this injury Mac I was suffering from metatarsal pain (nagging dull ache for months) when the pain went from bad to worse instantly. An MRI revealed a torn plantar plate ligament(Grade II). I narrowly avoided surgery. Are you still running? Do you get burning into your toes? Do you limp during or after you run? If you look down at your foot does the toe look like it is deviating away from the other toes towards you big toe? Do you have any other foot condition like bunions? Did the doctor place the metatarsal pad for you? Did the doctor recommend anything else? From your description I fear you are being underserved and your condition is being given the chance to worsen.
If you not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time today, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Laura 20-08-2013, 00:53

It started in February 9th 2013, wearing very very high heels, I was standing for a long time and then felt down ( the street was quite rocky).. I thought it was something simple.. But I couldn´t wear high heels any more the pain in the ball of the foot was burning, like they were inserting needles there…
I took Tafirol AC for 1 week (Paracetamol, Diclofenaco)
One week after I realized I couldn´t bend any of my toes.. it was completely stiff, I could bend them upwards, but not downwards…
I went to the orthopedist Feb 19th, he took and X.ray…. said it was a very small fissure… he gave me Tafirolflex ( Paracetamol /Clorzoxazona) for 1 week, and but my foot in hot water…
After a week he said I should take Celebrex (Celecoxib) It didn´t work at all..
March 4th, I went to see another orthopedist he said he did not see any fissure in the previous x-ray.. and took a new one.. he said he didn´t see anything that it was inflammation.. he sent 8 injections of Dynastat (Parecoxib) one daily!!! I told him It was too painful I couldn´t walk very well he said mm it is only inflammation…
It didn´t work.. he sent me to take an MRI.. I guess he just based in the interpretation of the MRI which says it is the sesamoid bone.. but I don´t have that much pain in that area.. the pain was mainly concentrated under the second and third toe.. but I believed him.. He put and air cast.. I used it for a week and the pain got worse.. my back was killing me..
Then I saw another orthopedist in Houston, Tx.. he was general orthopedist he said he didn´t know what was going on.. We went with the MRI department he said he saw the foot specialist and asked him and said to wear a rocker bottom sole for 2 months at least.. I used it for a week but my back was killing me and the other foot..
Then I saw an orthopedist ( foot specialist) in Mexico City, he took another X.ray and saw the MRI and previous X-rays and said it was Tenosynovitis, I went to physical therapy every day until I had 30 sessions, I had 3 cortisone injections (Betametasona) and every day I was taking Bristaflam (Aceclofenaco) twice a day for 2 months and Constrast therapy at home (cold and hot – 1 Minute each- for 15 minutes twice a day). I could bend my toes after Physical Therapy, but the ball of the foot pain wasn´t gone I still have the intial pain same place, same feeling burning like inserting needles if I try heels or only put my weight in that part.. He asked for electromyography and nerve conduction velocity and the result was negative, everything is fine with the nerve.. In the x-ray you can see that the space between the second and third toe is reduced the bones are really closed compared to other toes.. so he though It could be a nerve compressed.. but it wasn´t.. He asked for a blood test to see it was a rheumatic problem.. it was negative…
Then I went to see an naturist doctor and took some natures sunshine´s supplements.. I went to acupuncture.. didn´t work at all…
In July 16th I saw another orthopedist in Mexico is also foot and ankle specialist… since the begging he said it was a plantar plate tear in my second toe.. ( he said it was difficult to see in the MRI) but he thought it was a partial tear, and I used crutches with no boot for 1 month, and he taped down my second toe and I still do that every day..
August 12th I had a new MRI of both feet, he asked to cleary take my plantar plates… The result was that I have a partial tear of the plantar plate for the first and second toe… Inflammation between the second and third toes, (bone edema was mentioned from the MRI). The Doctor mentioned in the MRI he can see Freiberg’s, but he says is not that clear on my foot, sometimes when I was using the crutches my toes were a bit pinkish-purple.. I took total rest for 2 weeks and put my foot elevated.. Constrast therapy (cold and hot – 1 Minute each- for 15 minutes twice a day) for 5 weeks now… Now taking Voltaren (diclofenaco) since last week and still hurts… Another thing the MRI said its edema of the medial sesamoid (first toe) (the sesamoid when the doctor puts pressure on that bone is not painful but it still bad in the MRI)…
They mention synovitis on the flexor tendon of the first toe…
The doctor said I need a cortisone injection I am not very convinced since I read that it could affect the soft tissue and it is not a good option for plantar plate as it wont heal it…
I asked about Plasma Injections, he said he has not tried for this injury but for other things he used it not always had a positive outcome..
And he said sometimes plantar plates never heal.. he is not thinking about surgery.. and now I don´t know what I could do..
I haven´t been to the gym, just walk the necessary, never used the high heels again, I used flats at the beginning then they told me to use wedges with a tiny high heel.. and now I am wearing the skecher shape ups every day since last week and the tape for the second toe…The pain hasn´t change much.. In the MRI you can see a lot of liquid still…

Dr. Runco
Dr. Runco 21-08-2013, 12:51

Hi Laura,
I am sorry to hear about your plight…… I am an expert in this injury and would be happy to help you out. You are suffering from a plantar plate tear and they can most definitely heal! You provided me with an excellent history and you already have had an MRI to confirm the diagnosis so ignore most of the “template” paragraph below. There are many things you can do to avoid surgery but they have to be done asap and done correctly.You should call my office at 858-268-8525 so that I can counsel you on your condition and let you know about your options. I have treated and corrected this condition in hundreds of runners and non-runners from San Diego to New York to Florida. Please fax your MRI report to before we have our phone consult. Stay positive, have hope and be optimistic Laura. I believe that after discussing your situation with me you will feel more confident moving forward, be aware of all your options and be better able to choose a competent doctor in your area. Are you currently in PT? What else have you tried? How old are you Laura? Have you tried orthotics?
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time tomorrow, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Allyson 23-08-2013, 01:26

I’ve been suffering with 2nd MT pain for ~8 mos. Received a steroid injection in the joint and a nerve block that helped initially, but the pain has returned. I have never had an X-ray. I am now pregnant and still suffering with the pain. Bc of the pregnancy, I’m unable to have an X-ray or MRI to formally diagnosis the issue. How do I know if it’s a Grade I or II sprain? Any other conservative suggestions please for this pregnant lady besides orthotics and taping, which do help?

Patricia Miera 24-08-2013, 01:03

Doctor:

Seven years ago I had surgery for a hammer toe. Everything was fine until the doctor took the pin out of the toe, It stuck straight up in the air. So the doctor did surgery again, didn’t do much good. I went to a third doctor who diagnosed my foot with a screwed up 2nd toe and a plantar plate rupture and flat feet. She went ahead and did the surgery. She fixed the toe and removed a bone and tightened the ligament of my big toe and tried to repair the rupture. She told me the plantar plate was totally shredded and she fixed it as best as she could. She said it could not be repaired like she had hoped. Well, it still hurts at times and remains swollen, compared to my other foot. I lost the orthotics I was given(I retired from the military and lost them in the packing, don’t ask me how). Should I see another podiatrist and get new orthotics? Should I keep taking motrin? Now my knee is being affected with my limp and my back. I’m just a mess.

Dr. Runco
Dr. Runco 26-08-2013, 18:03

Hi Allyson,
I am sorry to hear about you foot condition. I am an expert in this injury and would be happy to help you out. You provided me with an excellent history. I am sorry that the shots did not help…..that is typical. There are many conservative things you can do to avoid surgery but they have to be done asap and done correctly.You should call my office at 858-268-8525 so that I can counsel you on your condition and let you know about your options. I have treated and corrected this condition in hundreds of runners and non-runners from San Diego to New York to Florida. Stay positive, have hope and be optimistic Allyson. I believe that after discussing your situation with me you will feel more confident moving forward, be aware of all your options and be better able to choose a competent doctor in your area. Are you currently in PT? What else have you tried? How old are you Allyson? Have you tried orthotics?
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time tomorrow, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Dr. Runco
Dr. Runco 26-08-2013, 18:07

Where do you live Patricia? Maybe I can recommend somewhere else?

Dr. Runco
Dr. Runco 26-08-2013, 18:12

Hi Paticia,
I am sorry to hear about your failed surgeries…… I am an expert in this injury and would be happy to help you out. Where do you live Patricia? I can make you new custom orthotics…or maybe find you someone in your area that can. Not all custom orthotics are truly custom and can vary in stiffness and flexibility. Having the correct type made for your condition is crucial if they are to be effective.
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time tomorrow, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

rick rappaport 08-09-2013, 02:00

Dear Dr. Bunco,

I was caddying for a friend and had to run (carrying his clubs) to catch up after I took a bathroom break. When I stopped some 280 yards later my right foot was in deep pain and I could hardly take a step.

Saw my PCP who diagnosed this as metataralgia but the excercises for it only exacerbated the pain. Went to a Podiatrist who said it was not MNeruoma but a fractured plantar plate, advised me to go lightly with activity and tape the second toe in a 15 degree downward angle to alleviate pain caused by the second toe pushing on the metatarsal bone. Icing and elevating, too.

He said a boot would be required if the pain persisted. It has persisted. Hoping for the best. Don’t mind 3 months gone from my active lifestyle if this diagnosis is correct.

Allyson 08-09-2013, 13:40

Yes, I am 32 and have been in PT for about 4 months without relief–dry needling the interosseous muscles. I have also been wearing orthotics without much relief as well. I can go through periods of being pain-free. I’ve started taping the 2 toe into plantarflexion. Any physicians in the New Orleans area you recommend? I really don’t want to suffer my entire pregnancy.

Dr. Runco
Dr. Runco 09-09-2013, 16:53

Hi Rick,
You could have;
1. Mortons Neuroma ( x-ray would not show that)
2. Plantar Plate Sprain/Tear (most likely diagnosis)
3. Capsulitis (might be secondary to Plantar plate tear)
4. Metatarsalgia (it is possible you have bone marrow edema in your metatarsals)
5. Stress Fracture (not likely but X-rays do not show stress fractures)

I am an expert in the diagnosis and treatment of these injuries Rick. I have seen hundreds if not thousands of runners misdiagnosed, told to get shoes or inserts by incompetent doctors, useless and needless surgeries for neuromas when in fact they have a plantar plate sprain/tear that eventually ruptures. If you feel the pain is getting worse that is a clear indicator that the damage to the bone, joint or ligament is worsening. I have a personal history with this injury Rick. I was suffering from metatarsal pain when the pain went from bad to worse instantly. An MRI revealed a torn plantar plate ligament. I narrowly avoided surgery. Do you get burning into your toes? If you look down at your foot does the toe look like it is deviating away from the other toes towards you big toe? Do you have any other foot condition like bunions? Has you doctor recommended anything helpful?
If you not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time today, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,

1. Provide me with a detailed history regarding when and how the pain started.

2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you

3. Anything you did on your own that may have helped or hurt

4. A list of any special tests including X-rays, MRI’s, blood tests etc

5. Any information you have I may need to know.

6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.

After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

petra stanfield 29-09-2013, 17:35

I had plantar plate repair (upper and lower) and two toes pint about 5 weeks ago. I am still on non weightbearing status. How long will it take for revovery and how great is the recovery outcome? What type od therapy/interventions are to be expected/recommented? What precautions should I take ?
Thank you in advance for your answers and wishing you a great day!

Dr. Runco
Dr. Runco 01-10-2013, 15:11

I am sorry to hear about the surgery Petra and hope you will make a full and complete recovery. Is your doctor/surgeon not advising you on your questions? Without knowing more about your case I will answer “in general”. Recovery will take 3 months to 6 months. I am guessing the surgeon will tell you to begin walking on it soon. They probably will not recommend PT. If they do expect boring “grandma” exercises to “strengthen” your foot. In my clinic we rehab patients as soon as possible by getting them walking and running right away on the Alter-G http://www.youtube.com/watch?v=P4zv60rTsOU
It is truly an amazing invention http://sdri.net/services/alterg-anti-gravity-treadmill/
Are you an athlete Petra? Do you run? How old are you?

Robert 02-10-2013, 21:08

I have a newly diagnosed plantar plate tear. MD says surgery since I’ve been in pain off and on for 10 mos. Just started wearing a walking boot with almost complete pain relief. MD says the likelihood of it healing without surgery is slim. Do you agree?

Dr. Runco
Dr. Runco 02-10-2013, 23:15

What is the degree of tear? Do you have a partial tear or complete? Do you have the MRI results to share with me? How old are you? Which toe/metatarsal is involved? 2nd? 3rd? Are you a runner? Athlete?

Robert 03-10-2013, 03:46

MRI is scheduled. Highly specialized MD said it was very likely plantar plate tear vs Freiburg’s infraction and based on my history and exam, it will likely not heal on its own. I am 30 yo and work as a nurse. Not an athlete. It’s the 2nd MT. The boot gives me almost total pain relief. Want to avoid surgery. Have a slight hammer toe deformity.

Jennifer 25-10-2013, 16:17

Great information. I was thinking meta fracture until I read this. Seems to be more of my symptoms. There is pain on the top of foot, but it mostly underneath – 3rd toe in. Had starting suffering from mild plantar faciitis few months ago and sometimes while running it would kick in This pain is worse when I walk without shoes and somewhat tolerable when running (but I’m sure I’m changing my gait). I have a marathon in 2 weeks that I do not want give up. Willing to rest for a week (no running) and tape for the run just to make it though. Hoping for no major damage and then a long rest to rehab after.

Dr. Runco
Dr. Runco 25-10-2013, 17:06

Hi Jennifer,
You could have;
1. Mortons Neuroma ( x-ray would not show that)
2. Plantar Plate Sprain/Tear (most likely diagnosis)
3. Capsulitis (might be secondary to Plantar plate tear)
4. Metatarsalgia (it is possible you have bone marrow edema in your metatarsals)
5. Stress Fracture (not likely but X-rays do not show stress fractures)

I am an expert in the diagnosis and treatment of these injuries Jennifer. I have seen hundreds if not thousands of runners misdiagnosed, told to get shoes or inserts by incompetent doctors, useless and needless surgeries for neuromas when in fact they have a plantar plate sprain/tear that eventually ruptures. If you feel the pain is getting worse that is a clear indicator that the damage to the bone, joint or ligament is worsening. I have a personal history with this injury Jen. I was suffering from metatarsal pain when the pain went from bad to worse instantly. An MRI revealed a torn plantar plate ligament. I narrowly avoided surgery. You can still do your marathon and minimize your risk of making it much worse.
If you not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time today, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,

1. Provide me with a detailed history regarding when and how the pain started.

2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you

3. Anything you did on your own that may have helped or hurt

4. A list of any special tests including X-rays, MRI’s, blood tests etc

5. Any information you have I may need to know.

6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.

After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Jennifer 25-10-2013, 20:00

I’m in Illinois and I haven’t seen a doc about this yet. I guess I don’t want to hear the “you have to stop running for …. weeks.” I’ll try to call Monday.
Plantar faciitis has been for a few months. This pain in relatively new – maybe 2-3 weeks? I should note my left hip was giving me some problems mostly because of overuse (3 marathons in less than 12 months and I’m about to do a 4th). Saw my PT on the hip (she’s a runner, too) and she thought most likely more of a rest issue than anything.
The pain right now is in my right foot. I’m guessing I’m pushing hard on my right because left hip is giving me some discomfort.
Left hip is better, but now the foot hurts. It’s always something.
Generally – hurts in the morning (plantar faciitis helping it?). Taped it and it was okay to run. Doesn’t hurt too bad when I run (made it through 18 miles few days ago). Hurts mostly in the evening after I take off my shoes. I’ve wore high heeled narrow boots at work and there was no pain. Hurt more when I took them off and walked bare foot. It is odd.
Will call next week.

Amy 15-11-2013, 08:21

Dr. Runco,

I am hoping you could give me advice. I am from California, 27 female, but am in the Netherlands for three weeks. I got here about a week and a half ago. Prior to getting here I went to a wedding, wore heels (normal heels I have worn many times), and the next day felt a little pain in my big toe joint. Nothing serious (or so I thought), I continued on my very active way: Pilates for 50min, walking 2.5-3.5 miles 6x week. For the next 7 days the pain did not worsen, I had no trouble walking or anything.

Last Friday, I did a set of jumping jacks (nothing out of the ordinary) as a cardio warmup and proceeded with my workout regimen and walking. Saturday, was a day off, but as the day progressed, my foot felt more sore. Saturday night, it kept me awake, the sheets on the bed made it hurt and it began to throb.

Sunday morning, I could not walk on it or move my big toe. I stayed off of it, but when I did need to walk in the house I walked on the side of my foot. I began to ice it. Sunday night, I could not sleep at all, severe pain and swelling in my big toe. Monday morning, it’s throbbing at the bottom part of my big joint, swollen, and I can’t touch my foot, bring it down to the floor or move my foot at all without shooting pain in the joint. Monday night, difficult to sleep, but the throbbing subsides.

Tuesday, I now can touch my foot, it’s less swollen, but I cannot bear weight, walk or move my toe. Wednesday, I go to an Expat doctor, and she says “Oh, just arthritis, you will walk in 2 weeks, just bad luck”. So I got crutches and went back home. It’s Friday. I can now move my toe a bit, stand up (but can’t put my foot all the way down to hold my normal weight), and can’t push off. There is still bruising right where my two bones meet – metatarsal and phalange, and the pad of my foot is still a little swollen.

My problem is, I don’t go home for 3 weeks, getting an MRI, X-RAY, etc is very difficult, and with the strange progression of this, should I get blood test to check for autoimmune issues? What should I do for the next three weeks? I don’t want to make it worse, but this city is not very “crutch” friendly, and I do not have a car. Should I start to walk on it if it feels okay to do so? I don’t understand the healing process because I don’t know what I did, it came on gradual and then all of a sudden I can’t even walk. Any advice would be so appreciated. I’m trying to get in touch with my general doctor at home, but with a 9-hour time difference, it’s very difficult to catch him.

Thanks,

Amy

Dr. Runco
Dr. Runco 17-11-2013, 19:23

Hi Amy,
You could have;
1. First metatarsal plantar plate tear Grade 1, 2, or 3 with 1 being least serious (bruising indicates bleeding…..more serious)
2. Gout (autoimmune…….should not see bruising)
3. Capsulitis (might be secondary to Plantar plate tear)
4. Metatarsalgia (it is possible you have bone marrow edema in your metatarsals)
5. Stress Fracture (not likely)
6. Sesamoiditiis (common under the first toe)

I am an expert in the diagnosis and treatment of these injuries Amy. The Expat doctor who told you you had arthritis is incompetent (you are only 27!). The injury is definitely more complicated and serious than that. Since crutches are not easy for you why not go purchase a comfortable sport walking boot for the remainder of your time. Their is a company called OSSUR that makes a low cut walking boot that I like a lot, the Rebound Air Walker http://www.ossur.com/?PageID=13644 Get yourself into the boot, do not wear heels, stop icing it and when you get back to the USA follow the directions below…..your GP is not going to be able to help you with this injury. If it is a plantar plate tear you will require the expert advice and guidance of me or someone like me to avoid the condition from progressing…..oh yea……no Cortisone for ANY reason! It is destructive to the ligament.
If you not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time today, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,

1. Provide me with a detailed history regarding when and how the pain started.

2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you

3. Anything you did on your own that may have helped or hurt

4. A list of any special tests including X-rays, MRI’s, blood tests etc

5. Any information you have I may need to know.

6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.

After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Alice 25-11-2013, 02:36

​Hi Dr. Runco,
Reading through this has been so very informative and helpful. I live in Idaho or I’d come see you tomorrow!
I have a diagnosed plantar plate tear. And yes it’s my Yoga and I feel like I am in the wilderness now.
Your input would be so appreciated.
The podiatrist I went to said I could walk briskly in a hiking boot. He did not put me in a walking boot.
I have been walking briskly 4 miles a day about 20-25 a week. My last two or three little toes feel sort of numb after 2-3 miles.
I run about 2,000 plus a year, am a marathon lover and for the past 3 years jumped to ultras (max run 62.8).
I am scheduled to run Boston 2014.
My 2nd toe is bent significantly. I understand it will never straighten.
I need to know what you recommend for activity during the healing (I have not ran for 6 weeks). Can I row with a boot on, walk briskly, run in the pool with a belt, swim…bike….Alter G treadmill? Please could you give me your recommendations and thank you so very much.
I would call you to visit about all this if I could….there is just nothing like a desperate woman…….
who needs help!
Thanks
~Alice

Dr. Runco
Dr. Runco 25-11-2013, 15:05

Hi,
I am sorry to hear about your plantar plate injury…… I am an expert in this injury and would be happy to help you out. You provided me with an excellent history and you already have had an MRI to confirm the diagnosis which is very helpful. There are many things you can do to avoid surgery but they have to be done asap and done correctly.You should call my office at 858-268-8525 so that I can counsel you on your condition and let you know about your options. I have treated and corrected this condition in hundreds of runners and non-runners from San Diego to New York to Florida. Please fax your MRI report to me before we have our phone consult. Stay positive, have hope and be optimistic. I believe that after discussing your situation with me you will feel more confident moving forward, be aware of all your options and be better able to choose a competent doctor…….your current podiatrist is not. If your second toe is deviated as you say (please take a picture from the standing position looking down at both of your feet. Make sure to get both feet in the picture so I can compare) it means your plantar plate is partially torn. Walking “briskly” for 4 miles is not really good advice….not in order to heal this injury. You are a long distance runner…..and from the sound of it a pretty good one. Your podiatrist is treating you like every other “Tom, Dick or Harry”…..a recipe to screw your foot up long term and have you end up on an operating table left with metal in your foot. Please answer the below questions regarding your “brisk hiking” to the best of your ability and email the answers to Brittaney before our phone consultation.
1. On a scale of 1-10 what was the pain BEFORE running (10 being the worst pain) 1————————————-10
2. On a scale of 1-10 what was the pain DURING running (10 being the worst pain) 1————————————-10
3. On a scale of 1-10 what was the pain AFTER running (10 being the worst pain) 1————————————-10
4. Were you worse the next day BECAUSE YOU RAN the day before? YES NO
5. Were you limping AFTER the run or later in the day AFTER the run? YES NO
6. If you were to run CONSECUTIVE days or run AGAIN LATER in the day would you be able to without significant pain?

Please keep this journal and monitor your symptoms. The answers to these questions will help be diagnostic to you condition as well as help to form a reasonable plan and level of expectation as to how long it will take your injury to heal.
If you notice that your condition is deteriorating please cease running and contact me prior to you appointment.

Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time today, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,

1. Provide me with a detailed history regarding when and how the pain started.

2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you

3. Anything you did on your own that may have helped or hurt

4. A list of any special tests including X-rays, MRI’s, blood tests etc

5. Any information you have or feel I may need to know.

6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.

After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Dr. Victor J. Runco
drrunco@sdri.net
sdri.net
dirtdevilracing.com
sandiegorunninginjuries.net

jose carlos patlan 11-12-2013, 03:29

hey doc, i have pain between my 4 and 5 toes , they told me i had a plantar plate sprint . my 4 toe moves just a little bit to the right anytime i put pressure on it and it gives me pain when it moves out of its place , u think i can heal just with rapping my foot and giving it rest ,and how long it may take to heal ? its being 2months and the only way i feel good with out pain is with wearing flip flops < but im going to start to rapping it and wear a special boot see if it goes away ,what u think i shoud do??

Dr. Runco
Dr. Runco 11-12-2013, 03:42

I would recommend you do a consultation with me. I have had the exact injury myself and treat & fix it in runners regularly Jose. There are ways to tape it but it has to be done correctly. There are boots and then there are better boots. Much in the same way certain types of running shoes may be helpful as you return to running. Give my office a call 858-268-8525…we are in at 8am tomorrow

Charles 22-12-2013, 17:10

Dr. Runco,

Was hoping for advice here. I have had painful athritis in my second toe for a few years now. A couple of weeks ago I started getting severe shooting pain at the base of the second toe. There was no acute injury, but I could not walk. Pain level 9/10. Went to see Podiatrist, x ray and ultrasound done. Ultrasound was inconclusive because of swelling, but doc believes there is a piece of bone that avulsed into my second toe. So I believe I have a plantar plate tear w/ avulsion. I was given a shot of cortisone and a little pad to put under my plate w/ instructions to carry on as normal, with another cortisone shot on the way. The pain has subsided for now but this makes no sense to me as a course for healing.. I am currently staying off the foot, and have a follow up in a week. I am a poor surgical candidate, and would refuse a procedure anyhow for many reasons. Would like to know options as to how to treat this injury or at least live with it and whether I should proceed w/ current podiatrist. Any advice is appreciated.

Dr. Runco
Dr. Runco 23-12-2013, 15:36

Hi Charles,
Sorry to hear about your foot.
1. Your podiatrist is hurting you with the cortisone! Cortisone is a CATABOLIC hormone meaning it is destructive to inflammatory enzymes as well as your LIGAMENTS AND TENDONS! Do not let him inject you again of your tendon will most certainly tear.
2. Your podiatrist needs his head examined! How on earth would putting a pad under an avulsed bone help in any way? It will not! You need to be in a walking boot Charles and protect the injury!
3. You need an MRI asap! (as well as a new doctor)

Charles I am available to help you via an appointment in San Diego or over the phone via a phone consultation to help guide you through this painful and limiting condition. Please take me up on this offer as I have seen far too many people injured by their ignorant doctors when attempting to treat this condition. You can call my assistant Brittaney after 12 noon today at 858-268-8525 and she can schedule the 1/2 hour phone consultation for us.

Cristina 07-02-2014, 17:33

Hi Dr. Runco,

I’m hoping you might be able to shed some light on my situation. Apologies in advance for the long backstory but I just wanted to make sure I was able to give justice to the journey me and my feet have been on thus far! I am, like most in this thread, a runner, or at least I used to be. About a year ago (Dec 2012) I started feeling pain under my my second toe joint on my left foot after x-rays and MRIs galore between orthopedic surgeons, rheumatologists and podiatrists, they diagnosed me with synovitis, saying that because my second toe was longer than the first I had over taxed my second toe joint. Furthermore, it was explained to me that with the way I was walking my big toe wasn’t bearing hardly any load, leaving the smaller joints to bear the burden. I used metatarsal pads and had a cortisone injection at the site, to no avail, custom half length orthodics made, then full length orthotics made and it looked like all might be healed, this was around April. I had another MRI and it looked like the inflammation had disappeared. They gave me the green light to start running again (as I had stopped entirely since about Jan/Feb of 2013 – forcing me to pull out of the Boston Marathon), which I did slowly but surely, working my way up to only about a three mile run once maybe twice a week at around 8/3:30/9 min miles flat. Then around end of July (so about 2-3 months later) my right foot (so the other foot) all of a sudden was in excruciating pain. In the same-ish spot, under the second toe joint. I was on vacation at the time so as soon as I came back I went to the podiatrist who made amends to my orthotics and sent me to the rheumatologist who put me in an aircast boot. I was in the boot for 6-8 weeks. At around week four when the amended orthotic was ready I put that in the boot as well. When I came out of the boot my foot was still very swollen and I still had a lot of pain. I then exclusively wore brooks adrenaline sneakers with my orthotics for 3-4 months. Concurrently the doctors ran all sorts of blood tests and the only thing that came back was some sort of “inflammation” in my blood, a sero negative result. However I was negative for all other tests, rheumatoid arthritis, lupus etc. I started anti inflammatories (naproxeon etc) and then arthritis meds (sulfazalosine) and steadily increased doses for 6 months. As I live abroad in london all of this took place in private clinics over there. I finally decided to come back home to the states, ny/nj area and go to the Hospital for Special Surgery in Manhattan. There I saw another orthopedic surgeon who sent me for a more specific/better MRI (apologies for my ignorance) because it was his opinion that it was my plantar plate, which he couldn’t see in my previous 3 MRIs. Indeed when the results came back there was a depression of my plantar plate (although he didn’t talk about which level of sprain/tear as I see you’ve mentioned in your previous posts). He sent me to someone who made me a new ‘more aggressive’ pair of orthotics and suggested I exclusively wear shoes with a rocker bottom sole, specifically Scott e-ride sneakers, which I have been. She also suggested I not walk barefoot at all and suggested I get a pair of crocs and fit flops for when I can’t be in my sneakers which I have. I’ve been following this course of treatment only for about 1.5 weeks now and am set to go back to the doctors in 3 to gage progress etc. so far it does feel a bit better when i’m walking around but it’s still painful especially when I probe the area. In the meantime I’ve also tried acupuncture and epson salt soaks to attempt to relieve the pain.

All that to say I guess I’m just a bit desperate and don’t want to go through this for another year waiting to see if it will work before soliciting other opinions. I’ve had to take a sabbatical from work and am just tried of sitting around unable to be active. I’m completely at my whits end here!?! I’m dying to be able to do something, anything! And it would just break my heart if I could never run again. I’m thinking about trying to squeeze in a weekend trip to California while I’m home, do you take last minute patients? Do you think it would be worth a consult? Please help!?!

Thanks in advance for any advice you could offer. I would be incredibly grateful for any suggestions!

Dr. Runco
Dr. Runco 07-02-2014, 21:58

Hi Cristina,
It would definitely be worth your while to come see me. I Have many ways of dealing with this issue to make it better. Cristina please email me at my personal email drrunco@sdri.net and give me your phone number and the date(s) when you are coming to California and I will have someone from my office call and schedule you. I look forward to meeting you….and helping….fyi I am from NYC too :)

deb pezzuti 24-02-2014, 13:50

I am scheduled for surgery tomorrow and I am terrified for plantar plate tear. No one has told me what grade it is and the last dr didn’t BOTHER looking at the MRI ..I have done conservative treatment for 2 years.

Dr. Runco
Dr. Runco 24-02-2014, 14:03

I am being as honest as I can be here……if you are scheduled for surgery tomorrow and emailing an anonymous doctor (me) the day before what do you hope to gain or want me to say? Why would you allow someone to knock you out, lay you on a gurney and cut open your foot……to do what kind of surgery exactly? If you are not sure and do not have confidence then maybe you should call of the operation Deb.

Mel 12-03-2014, 09:46

I too have a plantar plate tear. Firstly diagnosed as bursitis for 4 months until an ultrasound revealed the injury and unfortunately arthritis. My orthopaedic surgeon is reluctant to operate and I have been referred to a Podiatrist to firstly try the conservative method which sounds like the method you would have chosen too.

I have been wearing the orthotics for the past 3 weeks, the process being very uncomfortable however I am under the opinion this process is no pain no gain.

Id appreciate your feedback and will keep every one here posted on my very slow mending process. Im gathering patience is advised

Dr. Runco
Dr. Runco 12-03-2014, 13:09

Mel I highly encourage you to use me as your patient advocate for this injury. Treating plantar plate tears is tricky and not as straight forward as may seem. For example; the degree of tear dictates how aggressive the course of action should be. Liken a plantar plate tear to a cut on your skin….they are both tears. If you have ever had a small cut on your skin you know it hurt, it bled and it healed without surgery or even stitches……skin is connective tissue exactly in the same way a ligament is connective tissue it just has more blood supply so it can heal a little easier and faster. Now imagine a serious gash on someone’s skin, a jagged deep cut that requires serious stitches and leaves a nasty scar. Both of these scenarios illustrate tears to your skin but each circumstance requires totally different interventions and end up with completely different outcomes. The same is true of your plantar plate ligament. It is vital to know how severe or the degree that the ligament is torn.
When instituting a treatment regimen it is important to consider the severity of the tear and then to protect that tear form further injury. In some instances a very stiff walking boot is required while in others a rocker bottom shoe may suffice and yet in others an orthotic with a properly placed metatarsal support may suffice…..depending on the severity of the tear. Let’s look at each condition briefly;
1. Walking boots – are not all created equal. You can have a very comfortable walking boot (I’ve personally tried 20…some are horrible) or you can have a useless uncomfortable boot that actually aggravates your foot………UNDER NO CICUMSTANCE SHOULD YOU DO ANYTHING TO AGGRAVATE YOUR FOOT!
2. Rocker bottom shoe – can prevent you from flexing your plantar plate and walk without pain…if the tear is not so severe. Allows for more function when compared to a boot. Boots also tend to make you feel like one leg is longer than another and can cause you back issues.
3. Orthotic with metatarsal support – If the orthotic is uncomfortable and the metatarsal pad is pushing up on the injury IT IS MAKING IT WORSE! I do not care what the dopey doctor tells you….pain is not your friend and should be avoided at all costs. Pain is your body’s way of telling you there is a problem. Listen to your body….it knows best.
4. Metatarsal pads/supports – if not placed properly will aggravate your condition. Metatarsal pads can be adjusted to a persons foot size, body weight and shoe type. If you place a thick metatarsal pad that does not give under a 100 lb women I can predict the outcome. The same metatarsal pad under a 200 lb. man will probably work fine….same metatarsal pad but completely different outcomes. Most doctors use the same hard orthotics and same unforgiving metatarsal pads that aggravate patients plantar plate….do not let them do this to you!
I have seen so many patients follow the well intentioned but completely misguided advice of doctors incompetent in this area only to end up with pain for years. I can help you end this pain quickly. Modestly aside I am the authority on this injury. Not only have I treated it and learned from my experience over the last 14 years but I actually had it 2 years ago…I know exactly what it feels like and how to get it to heal. There are simple measures that can be implemented to allow this injury to heal but it has to be protected and pain free as possible.
Please call my office after 9am today at 858-268-8525 and Krista will schedule you for a ½ hour phone appointment ($125) where I can go over this injury in detail with you, make sure you as educated as possible about it and have as much information going forward so that you can make the best possible decisions regarding your own path to getting better. After our phone consultation you will fell 100% more confident in the direction you decide to take and manage your condition back to health.

Adrian 13-03-2014, 05:26

Hi – First of all, thanks so much for such a valuable website. I have been seeing a local doctor about a severe pain experienced in the ball of my right foot, in line with the 3rd toe. I had been doing a lot of jogging and hiking, and also training with a heavy pack and boots. Never had a problem with any of that – but walking back from the supermarket one day in a thin-soled pair of shoes, I suddenly experienced a shooting pain that was just too painful to walk on. I stopped running and let it rest but the pain didn’t really get any better. I eventually went to a doctor for an X-ray because I was concerned I had a stress fracture. The x-ray didn’t show anything unusual but the doctor said I had a high-arch and that I’d got tendonitis. He put me on a course of ultrasound and physio, but actually it didn’t make any difference. In the end I bought an expensive arch-support insole from a sports shop, and then started modifying it by adding padding under the metatarsal heads and additional arch support to spread my weight over a wider area. This seems to have made a difference, and I can now hike and jog pain free.

My question is – does this sound like a planar plate tear to you? And if so, as long as I remain pain-free, would you say my remedial strategy is good?

Dr. Runco
Dr. Runco 13-03-2014, 10:46

Hi Adrian,
Thank you for the compliment, I put a lot of effort into my website. From your email description I am going to give you my best estimation based on the probabilities. Most likely you did not have a plantar plate tear but rather bone marrow edema (bruised bone inside the medullary cavity). Had you suffered a plantar plate tear you most likely would have had to immobilize your foot as any bending of the ligament will typically cause pain and delay healing.
There are 3 basic Arch types. High (Pes Cavus), Medium (Pes Rectus) and low (Pes Planus). High arched individuals do not spread pressure throughout the entire bottom of their foot in the way flat footed people do. Pressure is typically directed through the ball of the foot and heel. Combine this with running and you have high, repetitive impact on the ball of the foot and increased impact forces that can result in bone trauma. X-rays would not show bone edema nor would it have shown a stress fracture or tendonitis for that matter. I do not know what the doctor based his/her diagnosis on but in my experience most doctors never even touch the area and will somehow declare it to be tendonitis…..if questioned they usually can not even name the tendon they are pronouncing to be “itis”.
You then got expensive arch supports from a sports shop and started modifying them. Congratulations you are now a custom orthotic maker (if you would like to interview for a job please give me a call…..I could use another custom orthotic maker)! By customizing your arch support molds you did an extremely intelligent thing that makes a world of sense…..you added metatarsal pads and additional support to “spread weight over a wider area”. This worked because it redistributed forces throughout your entire foot and not just on the ball of your foot and 3rd metatarsal. You must be an engineer…….or at least you think like one 
If you are pain free than there is no problem and your strategy was a great success. Pain is your body’s way of letting you know there is a problem. We are all hard wired this way so we can protect ourselves from further injury. If you place your hand over a hot open flame it hurts so that you have a warning sign that damage will occur if you do not move your hand…..so you move it. If you move your hand further away you do not feel the heat thus no damage. Continue running and monitor the area for any worsening of the condition…..it should be fine from your account. If you have any more questions feel free to email me at DrRunco@sdri.net.

Michele 30-03-2014, 11:54

Thank you for your website. When I read your planter plate tear I knew you knew exactly what I am experiencing. I think you are the only website out there that is an expert on this and because it’s on your homepage it must be very important. I was just diagnosed after two years of “neuroma or hammertoe” types of treatment with cortisone that my MRI revealed a “tear” with the 2nd toe or on your site as grade 2 type sprain. I am wondering what makes you decide surgery or boot? My Podiatrist offered both and since they both involve the boot I thought “maybe surgery will fix this from ever tearing again”. My previous experience with turning down surgery on my shoulder is that after so many cortisone shots it broke down from a partial tear to a full tear. I was in surgery in 2 weeks from that MRI. I don’t want my foot to end up the same emergency situation and total pain because I turned down surgery. What is your patients experience with the “stiffness” in the joint after surgery due to scarring from the plate repair? And why would you shy away from it? What are the risks?

Dr. Runco
Dr. Runco 30-03-2014, 16:29

1. Do the boot first….you can always have surgery
2. As far as I am concerned the word podiatrist typically means “Incompetent” find an orthopedic foot surgeon that specializes in foot/plantar plate
3. Your Podiatrist has already mis-diagnosed you once and damaged you with cortisone. Don’t let them inject you again. Cortisone is a catabolic hormone, meaning it is destructive to inflammatory enzymes….and your tissue in this case your plantar plate. I hope your realize that and understand what actually occurred to your shoulder. You had damage and they shot it with cortisone allowing you to not only make it worse but the cortisone itself helped destroy your tendon and set you up for surgery. Nice racket those doc’s have eh?
4. There are many, many other things besides a boot you can do to avoid surgery Michele. I would like to help you and become your patient advocate. I have helped hundreds of people around the USAA and Europe by functioning in this regard. If you would like my help with this please email me at DrRunco@sdri.net and we can set up a phone consultation where I will go over your injury with you, explain how it happened, tell you how to manage it without surgery so that it also heals 100% and make you much more comfortable with knowledge going forward.

Liz Cannon 01-04-2014, 14:35

So glad I found your site, maybe you have that magic bullet I’m looking for! I’ve had the pain you explain under second metatarsal head, foot surgeon/orthopedist said he thinks I”ve got a plantar plate tear, but no mri. Like you, he said surgery should be last resort (I have hammertoe and bunion on both feet.) I work in a physical therapy office, have access to ultrasound and stim with heat/cold any time. Doctor gave me met pads and toe spacer socks. Did I read that you don’t want the foot to be flexed? Any exercise/movement suggestions? Heat or cold? I had a morton’s neuroma removed from the other foot a year ago, and surgery was replaced with extreme bursitis and possibly a stump neuroma. Both feet are in extreme pain, of course now my whole body is in pain due to compensation and gait change. I can’t run at all, barely walking. Help!!!

Dr. Runco
Dr. Runco 01-04-2014, 14:42

i would be happy to help you Liz. I can set up a phone consultation for you if you like. At that time we can review any and all options you have that will help you avoid surgery. I am an expert on this condition and while I would prefer to physically examine you and speak to you in person i can be effective over the phone and help guide you through this terrible condition. If this is something you would like please contact me at my personal email DrRunco@sdri.net
Not only do I treat and fix this condition regularly but I had a grade 2 tear myself that I fixed without surgery. In fact my most recent MRI 3 years post injury does not even show any scar tissue and i’m running a 50 Km Trail Race on Saturday…shout out Oriflamme 50K!I am also running the PCT 50 Mile Trail Endurance run on May 10th….no foot issues whatsoever. I look forward to helping you Liz

Liz Keogh 13-04-2014, 04:07

Hi there,
I too have had a plantar plate tear. After trying different things for 6 months, pads, taping etc I had surgery. I also had a bunion ( hallux valgus ). The surgery was to repair the tear and fix the bunion. I had this surgery in July 13. It was called weil something. Prior to this injury I was a recreational runner- ran up to 6 or 7 Kms slowly per week with a training group. After surgery I did nothing for 5 to 6 months and then have returned to my group but only walking and upper body strength activities. The problem I have is continuous swelling under my foot. If I stand all day or am on my foot for long periods I feel like a painful lump is under my foot. I have iced it , had massage twice a week initially to reduce the swelling and now every time it seems to inflame. My surgeon says the surgery was successful but my recovery seems to be long. After severa weeks back at training I ran for about one kilometer and end up with a sore foot again. In fact my foot always seems to be a little bit painful. I wear shoes that are orthotically correct. Should I be doing different things? Exercises? My physio says I havea chronic condition and when I push it it becomes acute and sweets again. My family have a history of bad circulation.
Any thoughts ? Any ideas that may help me recover?

Dr. Runco
Dr. Runco 13-04-2014, 13:32

You need to try specific running shoes that help many with your problem. They don’t fix it but often help. It also seems that your surgeons idea of successful and your own are not the same. Your physio’s opinion is that the surgery was not successful and you are left with a chronic condition. You need to try custom orthotics with metatarsal pads, HOka Running shoes and PRP injection into the plantar plate.

Chris Phillips 22-04-2014, 17:54

I have been to 3 different doctors at different times after I felt a ton of pain in the ball of my foot during my last run 2 years ago. The first Dr told me I had pre-dislocation syndrome and prescribed a steroid pack and an anti inflammatory. That medicine took me from a pain level of 9 to a 2 in 3 days.

I waited for several months before running again. Walking I had very little pain, but after my runs (or during sometimes) the pain would come back. Trying to avoid surgery since I’ve already had 2 major back surgeries, I kept hoping things would heal on their own. That didn’t happen, so I went to see a 2nd Dr. He told me that I had hammer toe, recommended surgery and had me tape my big and 2nd toes together for maybe 2 – 3 weeks, along with inserting a metatarsal pad on my expensive running store insoles. This helped quite a bit with walking, but still every time it went back to running the pain, although not nearly as bad, would come back.

Finally, 2 years after this injury I finally decided enough was enough and went to a 3rd Dr to request surgery. This Dr diagnosed the injury as a plantar plate tear. So, 3 Dr’s and 3 different diagnosis.

I am actually scheduled for Surgery in 2 days. I called the hospital to find out the facilities charges and was BLOWN away. Procedure is about 1 hour according to my Dr, along with a 2 hour recovery.

Surgeons fee is about $3,000, anesthesiologist is $750 for 1 hour, and the facilities bill is $15,000. Those are the rates that are contracted with my insurance company – United Health Care.

I couldn’t even BEGIN to imagine anyone charging $15k for a 3 hour hospital visit. For that price, I’d want the entire hospital staff in my room during the entire procedure and recovery. Really? $15k for a 3 hour visit? By the way, this is in Lincoln, NE.

I called the Dr’s office to ask if the Dr does this procedure somewhere else and they told me of another place. I called them and the contracted rate for the same procedure was 1/5 of the hospital – $3,300.

I’m writing this in case this might help someone out. Make sure you know what the facilities charges are because they obviously vary drastically in cost.

For $15,000, I’d choose to just walk with no pain and know I couldn’t run. For $3,300, I’m getting it fixed.

What a bunch of crap our medical system is. I hope i never need to go to the hospital. Freaking ridiculous.

Dr. Runco
Dr. Runco 22-04-2014, 22:04

I hope the surgery fixes your torn plantar plate Chris. Sorry you had to learn the truth about our medical system the hard way. Now you know. To be clear Doctor’s 1 and 2 were…………incompetent. “Pre-dislocation syndrome” is another way of saying you have damaged ligaments….er….maybe a damaged plantar plate doc #1?
Doctor number 2…another genius told you that it was a hammer toe. A hammer toe happen BECAUSE of a plantar plate…google it doc! The 3rd doctor diagnosed accurately what the first 2 actually already diagnosed….they just did not know it!
We are stoked you found a facility that charges way less to host the surgery. Good luck with your foot and your recovery Chris!

Gerard McDermott 27-04-2014, 11:27

Hi, my name is Gerard and I live in Sydney, Australia. I recently completed an Ironman Triathlon but was suffering with substantial forefoot pain for 4 months leading up to the event. I saw several medical people and varying diagnosis. I was given 2 cortisone injections which didn’t assist me very much. It is now 5 weeks since the Ironman, which I was able to complete under my goal time but the last 20km of the run really hurt my foot. I have recently seen a foot surgeon (specialist) who believes I have a planter plate tear. I am now completely resting from running for the first time and I am having orthotics made as well. I was told that I could continue to swim and ride my bike but that it would take several months to heal. If after 6 months it hasnt healed then surgery is the recommended action. Clearly, given that I live in Australia there is not much you can do for me. I really wish you were local as you really seem to know all about this particular injury. I was hoping you could answer one question for me. That is how important do you think it is that I wear a boot during this healing time as my specialist did not mention that. Also, do you agree that it is OK to swim and ride during the healing time. Many thanks !!

Dr. Runco
Dr. Runco 27-04-2014, 15:50

Sorry about the foot Gerard. The purpose of the boot is to limit any flexion of the toe/ligament thus giving it the best chance to heal…..any aggravation of the injury can worsen it. SO yes, I think a boot necessary for at least the first 6-12 weeks. Swimming and biking (no flip turns) are fine.
The OSSUR low cut walking boot is my preferred boot

Mike Shipley 03-06-2014, 17:46

I’m looking for some advice. I tore my plantar plate two years ago. We finally found in an MRI last summer after months of rehab no working. I wore a flat walking shoe and taped my toe down(second metatarsal) for three months. It was not a complete tear so it was a grade 1 or 2. I had no toe or joint deformity. My toes have the natural raised look in general. So the boot was removed in September and I have been in rehab ever since. We’ve been doing the rehab once a week which involves a deep tissue massage if you will to stretch my calf and hip. So I get the rolling buzzing around my foot and has slowly been going away. We do balancing and footwork excerscizes. So it’s been 9 months and not “healed”. I’ve read on here it can take up to a year. To my question is can it take a year or longer to get the tendon back to normal and the atrophy out of my foot from the boot? I’m on the beach this week for the first time since before the boot and it has made the second metatarsal ver sore. Thanks for any advice you can give. It can get depressing taking all this time.

Thanks

Mike

Dr. Runco
Dr. Runco 03-06-2014, 18:00

I can advise and help you with this condition but it will be necessary for you to schedule either an office visit or a phone consultation. If you would please call my office at 858-268-8525 we can schedule whichever one you prefer. It does not sound like you are doing what is necessary to fix it currently.

Katie Shea 22-08-2014, 12:31

Hi,

My 2nd toe is progressively moving on top of my big toe. I’ve seen a podiatrist who prescribed 10 weeks of an anti-inflammatory. I have 3 young children and don’t want to lose any mobility by just letting the toe continue to drift. Less importantly, the podiatrist showed me a picture of orthopedic shoes to order. I really would rather just get my foot back to normal, if possible. Is it possible, and how do I make that happen? Thank you

Dr. Runco
Dr. Runco 22-08-2014, 15:00

Hi Katie,
Sorry to hear about your foot. The answer is yes you can fix your foot. You have a torn plantar plate/lateral collateral ligament tear in your toe where your second metatarsal meets your toe. Ligaments help hold joints together which is why your second toe is deviating. This condition is sometimes referred to as pre-dislocation syndrome because your toe is moving out of its normal range.
The podiatrist you are seeing is either lazy or ignorant. Antiinflammatories are not going to help or fix this and neither is an orthopedic shoe. I highly encourage you to call my office today after 10am and ask Krista to schedule you for a phone consultation or office appointment with me. You need help from someone who knows how to correct this condition and I can advise you as I am an expert in this condition.

Laure Simms 29-09-2014, 17:05

Hi Dr Runco
Long stroy, I started having pain in the ball of my foot behind my second toe last Sept. I was three weeks out from a 10 mile race so I went to a Ortho foot specialist that diagnosed a Mortons Neuroma. Cortisone injection felt better and ran my race. The pain was more aggravating than anything. Between Oct 2013 and Feb 2014 I ran three 10mile races and three half marathons. The pain has come back and just won’t go away. I have numbness in my second toe at times as well. I have had this foot injected three times and still no permanent fix. Was told by a different doctor that I had Metarsal Capsulitis. After reading through your website it sound more like a plantar plate problem. Just wanting an opinon to request an MRI or what would be the best course

Dr. Runco
Dr. Runco 29-09-2014, 17:45

Hi Laure,
You could have;
1. Mortons Neuroma ( you have numbness into your toes)
2. Plantar Plate Sprain/Tear (most likely diagnosis. This is a severe sprain common in runners and can cause burning or numbness into toes as well)
3. Capsulitis (might be secondary to Plantar plate tear)
4. Metatarsalgia (it is possible you have bone marrow edema in your metatarsals)
5. Stress Fracture (very possible to be a stress fracture AND a Plantar Plate Sprain)

I am an expert in the diagnosis and treatment of these injuries Laure. I have seen hundreds if not thousands of runners misdiagnosed, told to get shoes or inserts by incompetent doctors, useless and needless surgeries for neuromas when in fact they have a plantar plate sprain/tear that eventually ruptures. If you feel the pain is getting worse that is a clear indicator that the damage to the bone, joint or ligament is worsening. I have a personal history with this injury Laure. I was suffering from metatarsal pain when the pain went from bad to worse instantly. An MRI revealed a torn plantar plate ligament. I narrowly avoided surgery. Do you get burning into your toes? If you look down at your foot does the toe look like it is deviating away from the other toes towards you big toe? (you can send a picture) Do you have any other foot condition like bunions? I strongly urge you to follow the instructions below Laure. After running well over 15 marathons and 10 ultramarathons in addition to treating injured runners over the last 14 years I have learned many “tricks” to help alleviate these types of conditions. I look forward to helping you.
If you not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $125 and by calling my office at 858-268-8525 after 12 noon Pacific Time Monday, Krista can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,

1. Provide me with a detailed history regarding when and how the pain started.

2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you

3. Anything you did on your own that may have helped or hurt

4. A list of any special tests including X-rays, MRI’s, blood tests etc

5. Any information you have I may need to know.

6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.

After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Callie 03-10-2014, 14:28

Dr Runco,
Are there any homeopathic aids that will help with a severe plantar plate tear? We are using the boot, and pads and while this has reduced some of the ball of the foot pain it has increased pain in the big toe. There are 3 stress fractures in the plantar plate (revealed by MRI) and 5 doctors opinions all have led to the this boot, different pads, and time to heal. So far it has been 7 weeks. However the pain is sometimes unbearable and the situation seems to be worsening.
Would things like icy hot naturals help with pain? Or Lemongrass oil massage into the area to help aid healing and pain? We do epsom salt baths. Can you tell me what ultrasound therapy is? And also could you shed any light on the different types of boots available? I see you’ve tried 20! We have only used one and it doesn’t eliminate the pain, but the doctor has not recommended any other types even though he knows that there is still alot of pain. Thank you in advance for your help. Your website is truly amazing -offers hope!

Dr. Runco
Dr. Runco 03-10-2014, 20:54

Callie would you prefer to set up a phone consultation with me? I think you would benefit greatly from it. If so call my office at 858-268-8525 and Krista can schedule it for you.
There are a few things you say in your email that don’t add up and concern me. I believe your doctors are leading you down the wrong path.

Callie 04-10-2014, 00:41

Dr Runco,
It is something Id consider, but Im not sure if my insurance would cover that sort of medical consultation.
I guess my main questions for you were just your opinions on pain reduction during the healing time. With adverse reactions to many anti inflammatory meds (hives) I am looking into homeopathic options. I saw you mention ultrasound therapy so I was just wanting more info on how that works.
I feel like were on the right path but may need to try different boots, pads. Im not sure what you mean when you say you believe we are on the wrong path? Diagnosis or treatment?
Thanks again!

Victoria Coleman 11-10-2014, 06:02

HI Dr. Runco
I like all other posts need to tell you finding this site has given some hope and insight into my PPL tear. I am a 5 year marathoner, a fairly serious runner. recently after some rock climbing and jumping in very poorly padded barefoot style shoes while holidaying in Arizona i developed fairly severe pain under my 2nd metatarsal area, more specifically acute point tenderness at the 2nd metatarsal phalangeal joint. In all fairness i had had some mild pain at this spot even prior to the hiking/running in AZ. i am a forefoot runner and have run injury free for years. I had swelling appear both on the plantar and dorsal aspect of my foot. like a dumb runner and doc (never doctor thyself) i came home and thought i would test this foot by a strong speed work out…BAD idea. i ended up very swollen and with dorsal bruising that become apparent the next morning. DUMB GIRL. after a month or trying ice baths, laser and what i called rest ( really not much rest at all) i had a bone scan and US. Clear Bone scan so no fx, but did show swelling of the bursa. no surprise. I then saw a very good podiatrist that deals with athletes. It took him 30 seconds to say it was more serious than I thought, and it was a tear (possibly full 3rd degree) of the plantar plate. we tried one week of taping but i am on my feet a lot, still doing elliptical, and biking…and foot was swelling and stabbing pain at the site. limping… that is a given if i exercise or by end of any normal day. I now had to succumb to a boot cast. I am waiting an MRI. I feel very hopeless and i now feel a bit of this happening on the right foot! nuts. not as bad but it scares me.
just wondering if i can keep doing my wts/elliptical/bike routine, should i water run, how long do i need the boot cast. if there is more you can share with me to get this to heal i would book in via a phone consult. i have an entry into Boston to run it again but feel very discouraged right now. i have been four days in a boot cast and HATE it but will do IF someone tells me it will truly help this!
up late researching in Canada hoping for answers.
thank you in advance!
Victoria

Dr. Runco
Dr. Runco 12-10-2014, 13:50

Hi Victoria,
First let me sat that I am sorry to hear about your injury. Below are the possibilities not necessarily listed in the order of likelihood but do cause pain in the area you are describing.
1. Mortons Neuroma – Do you have “burning” into your toes?
2. Plantar Plate Sprain/Tear (most likely diagnosis.) – This is a severe sprain common in runners. When you look down at your feet is your second toe deviating towards your big toe?
3. Capsulitis (might be secondary to Plantar plate tear) – The joint capsule is part of the plantar plate, medial collateral and lateral collateral ligament of the MTP joints for all practical purposes.
4. Metatarsalgia (it is possible you have bone marrow edema in your metatarsals)- Unlikely but possible. The MRI will show it…assuming it is a quality MRI
5. Stress Fracture (unlikely considering the CT scan for it to be a stress fracture AND a Plantar Plate Sprain)

I am an expert in the diagnosis and treatment of these injuries Victoria. I have seen hundreds if not thousands of runners misdiagnosed, told to get shoes or inserts by doctors that mismanage their condition because they do not truly understand the physiology of connective tissue healing and what it takes to heal a plantar plate ligament AND avoid the knife at the same time.. If you feel the pain is getting worse that is a clear indicator that the damage to the bone, joint or ligament is worsening. If any of the exercising is causing increased pain you are only damaging the ligament more. It now sounds like you are compensating and causing a similar issue on your other foot. I have a personal history with this injury Victoria. I was suffering from metatarsal pain when the pain went from bad to worse instantly. An MRI revealed a torn plantar plate ligament. I narrowly avoided surgery. Do you get burning into your toes? If you look down at your foot does the toe look like it is deviating away from the other toes towards you big toe? (you can send a picture) Do you have any other foot condition like bunions? I strongly urge you to follow the instructions below Victoria. After running well over 15 marathons and 10 ultramarathons in addition to treating injured runners over the last 15 years I have learned many, many methods to help alleviate these types of conditions without the use of surgery. I look forward to helping you.
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $125 and by calling my office at 858-268-8525 after 12 noon Pacific Time Monday, Krista can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,

1. Provide me with a detailed history regarding when and how the pain started.

2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you

3. Anything you did on your own that may have helped or hurt

4. A list of any special tests including X-rays, MRI’s, blood tests etc

5. Any information you have I may need to know.

6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL are competent.

After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Kimn Chartier, R.Ph 20-11-2014, 15:18

Dear Dr. Runco..

Right foot is extremely swollen, 2nd toe just crazy enlarged, can hardly walk. Started running about a year ago.. Dr’s said this is what caused it all. MRI states that I MAY have a partial thickness tendon tear near the plantar plate and a 3mm cyst. One DPM wants Orthotics (sp?) and another wants to repair the tendon. I am so over this all that I just believe surgery is my best option. The top of my foot is swollen as well as the bottom, I cannot bend my second toe. My question is with a partial tendon tear would surgery be the best option and why would not the first DPM who ordered the MRI even address that tear? I am sincerely tired of limping in pain and taking Medrol Dosepaks. Sincerely a frustrated RPH.

Dr. Runco
Dr. Runco 02-12-2014, 15:20

How can I say this……it is possible that the 1st DPM thinks or hopes that by taking pressure off the tear your body will be able to repair itself……and if it does not work then he/she can always operate. This is common practice in that it will appear they are trying to help you avoid surgery but it is possible they are sure it will not work and will end up having surgery anyway so they make money in two ways. I view this as unethical or ignorant. I am also skeptical of your diagnosis. Are you sure it is the tendon and not the plantar plate ligament itself. Can you email me a copy of the MRI report. Snap a picture and email to drrunco@sdri.net
There are many viable treatment options other than surgery but how you manage this condition starting now will dictate how well it will heal.

Tim 02-12-2014, 22:54

Hi Doc,

I developed pain in the ball of my left foot at the end of July while and stopped running altogether. I don’t recall having much pain prior to the day I stopped running except for some tenderness on the top of my feet but not enough to cause me to stop running. At some point after I stopped running, I noticed that might right foot had some, but less, discomfort in the same place. The condition did not get better over three months so in October I saw a podiatrist who diagnosed a plantar plate sprain. He recently sent me for an MRI and the result is that in my left foot I have a full thickness tear of the plantar plate of the second metatarsal and a partial tear of the plantar plate of the third metatarsal. On my right foot, I have a full thickness tear of the second metatarsal. I am surprised by the severity of the diagnosed injuries because I did not experience any swelling and my toes all seem normal, do not appear to be deviating, and touch the ground. My podiatrist thinks the condition developed over time and has recommended surgery on BOTH feet (w/ osteotomy because my second toes are long). I told him that I won’t do that until I have completely exhausted my conservative treatment options. I don’t have any interest in toe immobility or deformity, nerve damage, stiffness, or any of the other problems reported by those with surgery. Podiatrist has me taping both second toes with Budin splints, in orthotics that seem to shift my weight to my heels but no metatarsal pad or cusion, anti-inflammatories, and icing regularly. Too early to tell if there is improvement. I just want to get back to normal and run agian some day. I’m willing to put in the work to get there but need help with a plan and a reality check that I am not just being stubborn and can get there without surgery. I feel like I am in the same category as Victoria above except I have the MRIs to prove the bad news (although I understand that even MRIs are not so good at diagnosing PPTs). Help!

Tim

Dr. Runco
Dr. Runco 03-12-2014, 20:53

OK Tim. There are definitely ways to attempt to fix this without surgery. Please call my office at 858-268-8525 and tell them you want a phone consult. At that time I will outline a strategic and proven treatment plan for you. After that you will be confident going forward. The cost of the phone consult is $125. Please fill out the new patient electronic forms on my website at least 3 days prior to our consult

Marcela 29-12-2014, 09:23

Hi Dr Runco
I live in Australia, but would welcome your opinion. After a fun run I slowly developed all the symptoms you mention for planta tears. After three months of taping my toe and foot, wearing orthotics, anti inflamation medication and icing of my fore foot, I’m still in pain and limping. I had an MRI scan last week and results are, a high grade tear involving the lateral portion of plantar plate as well as an intermediate grade tear involving the medial portion of the plantar plate of 2nd metatarsophalangeal joint. Base of proximal phalanxis mildly dorsally subluxed. Their is also an an associated intermedial grade partial thickness injury involving the lateral collateral ligament. Bursitis in 2/3 interspace, oedema in adjacent soft tissue and fluid in 2nd metatarsophalangeal joint with reactive synovitis.
Do you you think I will heal with coservative therapy? Is it too late after 4 months of pain and 3 months of treatment to use a boot. Do I need to consider surgery at this stage? I’m a nurse and spend a lot of time on my feet, the limping is causing me hip and back pain.
Hope you can help, Marcela

Craig Nicholson 04-01-2015, 16:23

Hi Dr Runco,

I’m hoping you can give me more information regarding the recovery of a dislocated Great Toe/ Plantar Plate Tear – Hallicus Brevis Tear. Ihave now recovered from surgery which I had 27/09/2014 and I am now swimming, rowing machine and bike machine, however how long would it usually take for a complete healing process to take? My foot still swells and is sore but I have been told this is normal.

This injury occurred whilst playing soccer, however I failed to see the symptons after completing three half marathons earlier last year. I am a professional boxer, however I require to keep my weight down and my running is imperative to achieve this.

I was hoping you could provide some information regarding the recovery period of this injury.

Kind Regards

Craig

Dr. Runco
Dr. Runco 05-01-2015, 20:54

have you talked to the surgeon about this?

Dr. Runco
Dr. Runco 05-01-2015, 21:00

its sounds pretty bad but is hard to say if beyond conservative treatment.
1. Please take a picture looking down at both feet both sitting and standing/weight bearing. Email them to me at drrunco@sdri.net
2. What treatment have you had so far?

Laura 13-01-2015, 04:12

Hi! I’m in recovery from surgery after multiple wrong diagnoses. I’m just starting to run walk. In month 3…still stiff. Feel like my weight
is not distributing evenly- also, wondering if my arch_ could use slight support. Lastly_, running shoes you suggest after surgery to. Prevent ??
Laura

Dr. Runco
Dr. Runco 13-01-2015, 16:37

Hi Laura,
I am not sure which surgery you had…..but am guessing a WEIL osteotomy? Typically after plantar plate surgeries we recommend custom orthotics with metatarsal support and highly cushioned shoes to prevent excessive impact on the second metatarsal.
It is also important for me to understand what caused the injury in the first place as many plantar plate injuries are due to problems with the first metatarsal.

Wendy 19-01-2015, 19:50

Hello! at the Rock+Roll marathon this past Nov/14, i fell pray to a plate injury later stated by my Foot Doc. I have waited two months, without running, and i have noticed the fact that i can not make it a whole day at work without a slight limping pain. I really need to get back to running but how, if i cant even walk log term on it?? The Doc did give me an ortho to use and recomends stability shoes. I know about Hokas but i do NOT want to miss any important steps before i do more damage trying to run. It was labeled a “sprain”, the 2nd toe seems to be hammering over the last year rather quickly and seems to go hand/hand in time frame . i have seen the x-ray, and oddly enough, the bones look less wandered , was told spacing looks great. I am wondering…..is the ligament being stretched too far because of the hammer toe causing pain and the plate issue????? YES! I do get a slight relief if i tape the toe to others.

Dr. Runco
Dr. Runco 20-01-2015, 13:58

Wendy I can still help you at this stage. The toe is wandering and hammering because your ligament is damaged and no longer is stabilizing the joint as it should be. There is much that can be done at this point but in order to avoid surgery you must take action now. Please call my office at 858-268-8525 to schedule a phone consultation. Please send me
1. pictures of your feet sitting and standing
2. mark the exact area of pain and take a picture
3. send me any x-ray or mri reports
4. a bullet format detailed history starting with the initial date of injury. any doctors etc you saw. What was done that helped or hurt.
5. When you call my office leave your full name, that you want a phone consult and a number and time(s) you will answer. My staff will call you to schedule the consult.
I have helped hundreds of runners with this problem by providing them with effective treatment plans for their plantar plate injuries Wendy. I look forward to helping you and you avoiding surgery.

Kari Kienitz 20-01-2015, 19:25

Love your website, hating my foot issue! I was hit hard from behind by my fast speeding bullet of a dog last summer. Suffered from a medial meniscus tear of the right knee. Within a few days I noticed swelling and burning pain at the base of my toes, right foot. Anyway, my knee hurt so bad at the time I disregarded my foot issue thinking it was residual swelling from my knee. I am an active Crossfitter and up until that point had no injuries. Four months later, my knee had continued to heal but the pain, Swelling in my foot had not. I’m currently undergoing conservative treatment for a plantar plate tear. I have deviation of my second toe and some pretty intense burning pain, especially when I’m trying to sleep. Six weeks of toe taping and orthotics did nothing. Now I’m in week two of Naproxen and a boot, but am feeling frustrated because I see no improvement. My doc has also recommended rocker soled shoes which I plan to get this weekend. He also stated if there isn’t signific progress by mid February he wants to discuss surgery. I’m still active in modified CrossFit (obviously can’t run at the moment) 4 days a week and petrified of surgery but want my full functioning activities back. I also gave a Florida beach vacation planned for April and want to walk in the sand minus a foot contraption! Any further suggestions? ARP wave therapy?

Dr. Runco
Dr. Runco 21-01-2015, 01:31

HI Kari,
Sorry to hear about your foot. What kind of Rocker Soled shoes is your treating doctor referring to you getting. Mid-February is only 3 weeks away and based on what I have heard so far I do not think your doctor is very confident in treating this injury. Based on what you told me I do not anticipate you would see any improvement. I can help you avoid surgery if you like. What I need you to do is call my clinic at 858-268-8525 to schedule a phone consultation. When you call please leave your
1. full name
2. that you are a new patient that requires a phone consult
3. A number and time(s) you will answer so my staff can call you to schedule the consult
4. Please send me pictures of your feet sitting and standing while looking down on them
5. Mark the painful spot and send a picture of that
6. Take a picture of the orthotics….top and bottom to send me
7. send any x-rays or MRI reports
8. in bullet format send me a timeline of the injury, what has been tried, what helped or hurt and any other info you feel I may need to know
After our consult I will send you a detailed report outlining exactly what you will need to do to fix this issue and avoid surgery.

Michelle 22-01-2015, 21:23

I’ve been having pain in the ball of my left foot for about 16 months now. I’ve always had pain in the ball of foot if I walk too much and after walking around DC on vacation it was especially bad. I thought it would go away with some rest but after a month it was still pad so I went to a podiatrist that a friend recommended. He took an xray and didn’t see anything in particular. He told me it was bones pinching the nerves (I’m guess he meant morton’s neuroma). He gave me a shot in my foot and some metatarsal pads. The shot didn’t last long if it helped at all. I never could get the metatarsal pads in a position where they helped but didn’t hurt my foot. I limped around and walked funny for a year. Finally a few months ago it got so bad it was swelling and hurting on top as well so I went to an orthopedic that specialized in feet. She said I had metatraslgia (of course that’s what I told her when I went in, the ball of my foot hurts) and likely a stress reaction whatever that means. She had me wear a walking boot for a few weeks, get orthotics, and go to physical therapy. I’ve seen improvement, but I still can’t walk very far or very long. A trip to the grocery store does me in. I have to wear sneakers all the time, can’t go barefoot ever or wear even nice flats to work or church. It’s actually starting to get bad again and I’m feeling like I need to go back into the boot even though I wore it for 8 weeks already. One thing I noticed is that on my left foot the 2nd toe is closer to the 1st toe and there is a wider gap between the 2nd and 3rd toe than on my other foot. The pain is below the 2nd toe metatarsal head, but the bones of both the 2nd toe and the third toe will hurt to press on top and sometimes get to wear they hurt with bending and flexing. I’m supposed to go for an mri next week. I’m really hoping they can figure out what is wrong. I really feel like there is something wrong with the plantar plate, either a sprain or a tear. How I can convince my doc to look for that and not just a stress fracture?

Dr. Runco
Dr. Runco 23-01-2015, 03:22

Ask the radiologist to specifically rule out a plantar plate tear. Even if it is diagnosed correctly your doctor does not seem competent to provide you with an effective treatment plan. Ineffective doctors and ineffective treatment plans result in surgery on your foot. That is unacceptable. If you would like my help with this condition please call my office at 858-268-8525 to schedule a phone consult. After talking with you I will provide you with a specific and effective treatment plan so you can heal, avoid surgery and get back to running.
I look forward to helping you Michelle.

Howard 10-02-2015, 04:01

i am a mail carrier. on September 16, i was sorting mail at work. on my left foot, there was a sudden numbness and tingling. i saw multiple doctors, then I had an MRI, and it revealed that there were two tears in my foot. A “plantar plate tear of the left forefoot with capsulitis of the MTPJs”. I had to keep weight off of my foot for seven weeks and couldnt go to work. the seven weeks have passed, and i returned to work. my doctor provided a shoe splint for me as well as accommodative padding. today, after walking for an hour delivering mail, the numbness returned to my toes, heel and ball of my foot. there is no pain, however. does this mean my foot has not completely healed yet, or is there a new, different problem?

Dr. Runco
Dr. Runco 10-02-2015, 14:31

there could be a new problem although the numbness in the toes was the way it started in the first place so it may not be fully healed yet. Plantar plate tears can take up to 3-6 months to heal properly depending on what is done…..or not done to heal them and depending on the severity of the tear

Looking for options 04-03-2015, 20:12

Hi. I am not a runner, but have been diagnosed with a plantar plate tear. It hurts under my second toe, and that toe does not touch the floor like my other toes do. To begin with, the podiatrist had me tape the toe down. I did this for 3 weeks. There was no improvement. He then put me in a cam boot for one month. I went back for a follow up appt today. I have been wearing the boot all the time, except when sleeping. It does feel much better and I have no pain while wearing the boot. However, I still have pain just walking aross my house without the boot. I also still have pain when he presses the ball of my foot under the second toe. Today I was told that surgery is not only option left. He said I have a small bunion, and that is shifting the pressure on my foot and is contributing to the tear. He said at this point, there is no other option but surgery. I am just looking for advise. I live in OK and I have a job that I am on my feet all day long. Does this sound like surgery is the next option? Thanks you.

Dr. Runco
Dr. Runco 04-03-2015, 23:59

No Surgery IS NOT your only option…it might be the podiatrist only option but in the real world there are others for a plantar plate Grade 1-2 tear.
Do you have an MRI report?
You mention that your foot after a month in the boot feels better correct? Did this “so-called” doctor explain the physiology of ligament healing and give you realistic time frames for healing? It does not sound like it.
If your bunion is to blame and has caused transfer pain and damage to your second plantar plate do they plan to operate on that as well?
I would strongly recommend you schedule a phone consult with me Robin. Please call 858-268-8525 and Krista will schedule it. The cost is $125 and there is a great chance I will save you from needless surgery. After the consult I will send you specific treatment protocols for natural researched alternatives that will help you overcome this.

Marie 08-03-2015, 01:09

I would want to be one of your patients, but I’m in Flordia! It’s March now, I’ve had pain since July, an MRI noted a minor plantar plate tear in December, I wore a boot In December and January but in the seventh and eighth weeks it caused swelling and pain so I had to stop wearing it; and we were not seeing any improvement either. I’m taking ibuprophin now and the swelling is much better. I use only firm bottom shoes (new balance 928 with good insoles). I’m in physical therepy now but I’m concerned that they are doing the right things. They are working on ankle strengthening and movement since I was in the boot for so long. They are working in getting the toes to move because they are rather inflexible. They mentioned that a seventy degree angle is required in the toes for normal walking and I have only 55 degrees. I have had pain after the last two visits (but not during the visits) and I’m worried that it’s from when they bend my toes with their fingers. So my question for you, if you would be so kind as to answer it, is what sort of exercises would be good to consider for a slight plantar plate tear? Are these the right things to do to cure a plantar plate tear? I’m worried that these are they the things that would be done post op and are not right for me.

Dr. Runco
Dr. Runco 09-03-2015, 21:59

Marie I would recommend you schedule a phone consult by calling 858-268-8525. On our phone call I will provide you with detail of how to correct this injury the right away and avoid surgery. I will also email you a written treatment plan that is very specific as to what should and should not be done. Right now your gut is telling you the PT is not right….you should listen to your gut. Stretching the toes back toward the top of your foot to increase range of motion could quite possibly be tearing your plantar plate further.

Jason 19-04-2015, 01:53

Mr Runco, frankly I believe that one should not take any risks and directly go for surgery if he/she gets a severely torn plantar plate as in such a case one may risk losing his/her leg if appropriate measures are not taken. Yes, in case of a minor tear your suggested steps apply perfectly well.

Dr. Runco
Dr. Runco 20-04-2015, 09:40

Jason what is a “seveely” torn plantar plate in your opinion. Tears come in many varieties
Grade 1 – rarely requires surgery if treated appropriately
Grade 2 – Partial tear. May require surgery but if treated early in the process it demonstrates the ability to heal well. I know this because I suffered a partial rupture and healed perfectly in 4 months. I have run multiple 50 mile events since then and my foot is fine. I have been successful in helping hundreds of others do the same
Grade 3 – full tear or rupture. Will usually require surgery and I almost always advise it in this instance.

Dr. Runco
Dr. Runco 20-04-2015, 09:41

Jason what is a “severely” torn plantar plate in your opinion. Tears come in many varieties
Grade 1 – rarely requires surgery if treated appropriately
Grade 2 – Partial tear. May require surgery but if treated early in the process it demonstrates the ability to heal well. I know this because I suffered a partial rupture and healed perfectly in 4 months. I have run multiple 50 mile events since then and my foot is fine. I have been successful in helping hundreds of others do the same
Grade 3 – full tear or rupture. Will usually require surgery and I almost always advise it in this instance.

jason 22-04-2015, 08:46

I consider a Grade 3 tear as severely torn but as far I am concerned I would go for surgery even if there is a Grade 2 tear as you better be safe than sorry. Yes your rupture healed perfectly in 4 months, however 4 months is quite a lot of waiting time and that might risk further injury. What if you were to fall over or slip somewhere? What if you bumped your leg somewhere? To avoid aggravating the tear, I would go for surgery if there is a partial tear that would take a long time to heal naturally.

Dr. Runco
Dr. Runco 22-04-2015, 08:59

although what you are saying may have some merit it is not based on current healing models. Surgery always comes with implied risks the worst of which is infection. The recovery time from plantar plate surgery cna be 3-6 months and the outtcome is not guaranteed. When one wants to avoid surgery and the asociated risks they can
1. protect the area by wearig a sport walking boot
2. tape the toe into proper alignment to ensure the injured tissue is approximeted and will graft itself
3. do therpaies to increase blood flow into the plantar plate ligament to enhance nutrients and oxygenation of the tissue
4. gradually stress the injured area as it heals. Ligament is connective tissue and will respond positively and strengthen in response to proper stress
5. Return to normal activity gradually as the injury and pain lessen.
6. get custom orthotics with metatarsal pads to support the transvers/metatarsal arch and plantar plate ligaments
7. Consider modifying whatever the offending activity was that may have been responnsible for their injury
I have treated hindreds of runners and non-runners with various degrees of plantar plate injury…..many who failed surgery as well. While I appreciate your feedback your concerns are unfounded and not based on current medical models for tretment of this injury.

Cyndi 22-09-2015, 13:44

I was diagnosed with a planter plate tear…not severe enough for surgery. I walk without pain or limping, with my foot only bothering me after a long day or a hard workout. I take no pain meds since the pain is relatively minor and goes away with rest. A carbon-fiber insert was recommended, but I haven’t gotten it yet because I’m not sure it’s worth the cost. In your opinion, will the tear heal by itself if I do nothing? Would the carbon-fiber insert work, and if so, would I need to wear it all the time…I like to be shoe-less when I’m at home? If I only wear it when I go out, would it still be beneficial?

Thank you for your time,
Cyndi

Dr. Runco
Dr. Runco 22-09-2015, 18:08

Hi Cindy,
Do you have a copy of your MRI report to send me to review? I need more information regarding your tear and whether or not a carbon fiber insole would be helpful or appropriate. You state you have little or no pain and don’t take pain meds so it “sounds” like your injury is stable at the moment. Send the MRi report to DrRunco@sdri.net and I may have other more useful recommendations for you.

Karl 06-10-2015, 13:29

Dr. Runco,

I was misdiagnosed with Morton’s Neuroma in my left foot about four years ago. Took a couple of cortisone injections and kept running on it (not a lot, but about 20 miles per week). Two years ago, at the end of an 8-mile run, I felt a twitch and a rip under two toes (2nd and 3rd). Short pain, followed by minimal pain relative to the prior two years. Both 2nd and 3rd toes are now drifting and turning. X-ray diagnoses from podiatrist and (separately) ortho is that I have complete tears under both 2nd and 3rd. My question is two-fold: 1) is surgery necessary (i.e., will further damage result (such as damage to other portions of the foot) should I elect not to have surgery); and 2) what is the likelihood of this happening to my other foot (I’ve had fairly significant hammer toes on both feet since high school). I like to run, but I’m not built for it – 5’10” and 220 lbs. With three kids under 8, I will need to continue to move, and I’d like to know if the benefits of surgery are there, if I already have completed the tears and I’m in relatively low pain now. Thanks for your help.

Dr. Runco
Dr. Runco 06-10-2015, 16:35

The cortisone destroyed your plantar plate ligaments so you can thank Dr.Wyatt Earp for that……hammer toes put you at risk for plantar plate injuries because of the excess pressure on the ball of your foot due to your higher arches. Since running creates repetitive impact running then adds more risk for this type of injury. Take all into consideration and you have the perfect storm.
As far as the surgery that is hard for me to speak to. DO you have a copy of the MRI report you can send me? Not all surgeons are created equal either. Surgery is an art and not all artists create “works of art”. If in fact you have ruptured your second and third plantar plates and your toes are deviated it is due to the joint being essentially dislocated because there are no ligaments holding it together. Without a surgery to stabilize it your foot joints will continue to become unstable and you will develop problems in other ligaments….they tend to fall like domino’s.

Barb 20-10-2015, 17:37

HI Dr. Runco ~ I stubbed my toe badly at the end of July, and was later diagnosed with a partial plantar plate injury by my Podiatrist.(i’ts now mid-Oct.) He made it quite clear that he would like to avoid surgery for both his sake and mine…and after reading about the surgery, it sounds like it doesn’t always work anyway. I am wearing a little toe “sock” to hold my 2nd and 3rd toes together, and going to physical therapy, where they use ultrasound, some form of heat therapy(anadine?), massage and some exercises, to reduce the inflammation and hopefully help it heal. I was wearing a hard “sandal/boot” for about 4 weeks, but the Dr. said I can now wear sneakers. I can walk fairly well much of the time, but I do limp sometimes and do feel pain on the end of my toes and sometimes have an “achy” big toe…on and off. If I walk the dogs (quickly), it does hurt more….
I am wondering if there is still hope of it healing w/o surgery at this point. I think it is getting slightly better overall, but it’s been so long, that it’s hard to tell…Should I be doing anything more? Should I get a second opinion and see an Orthopedist? I just want this to get all better! I miss my walks on the track at the gym, and being able to just go for a walk w/o discomfort or pain…..
Help! ~ Barb

Dr. Runco
Dr. Runco 21-10-2015, 05:48

Hi Barb,
Pain is your foot’s way of telling you that injury is still occurring. The plantar plate is a weight bearing ligament and heals slowly. There are also different degrees of tears. A more severe tear may not heal without surgery while less severe tears can and will heal nicely if treated appropriately. In your case I would suggest you are being mismanaged. For example you state that you now wear sneakers but that you limp sometimes. Limping implies you are in some pain and pain implies there is damage and further insult occurring. I am going to provide you with a few examples of how I believe your case is being under treated or even mistreated.
1. There are shoes and sneakers that can be very helpful in terms of preventing pain while walking thus allowing your plantar plate to heal…..it does not sound like you have been provide with this.
2. There are orthotics and other insert interventions that are known to be helpful to offload the plantar plate such as metatarsal pads…..it does not sound like you have been provided with this
3. There are specialized injections such as PRP or Prolotherapy that can be injected into the damaged ligament to help it heal……it does not sound like this has been offered to you
4. You said in physical therapy they are “massaging it”. In my experience therapist often massage it to the point of pain…which causes more injury. If this is the case stop the massage
Barb, as with any injury if a plantar plate tear/sprain is identified early the treatment to fix it is conservative and with a high success rate. Your injury has been around for too long. The worse the injury the less likely conservative treatments will work and the person ends up undergoing a painful surgery often forever altering their skeleton. I have many suggestions that I can provide you that will help you heal quickly and avoid more pain and unnecessary surgery. If you would like to schedule a phone consultation you can by calling 858-268-8525. Phone consultations are extremely effective because I provide you with a thorough treatment protocol and other suggestions that have proven to get you out of pain, heal and get back to exercise. I will need a couple of things to help you more effectively. Please email me
1. Take a picture of your feet sitting and then again standing with no shoes or socks on
2. A copy of your x-ray or MRI report.
I Look forward to helping you Barb.

Jenni 03-11-2015, 14:26

Hello Dr. Runco,
I am an active 36yo and at the end of July I started to have pain while walking ( I was walking/running 6miles a day 5 days a week). I was orginally diagnosed w/ a possible stress fracture- 3 sets of xrays over the course of 2 months and no stress fracture. I went to my chiropractor who attempted to do US therapy but that actually caused me extreme pain while he perfromed the first treatment ( which I thought for sure meant I did indeed have a strees fracture) I was placed on crutches on 10/05/15 and told to be non-wt bearing for 4-6 weeks. After 3.5wks I still had swelling and pain with out walking, in fact the walking boot made my swelling worse. When I returned to see my podiatrist ( last week) I was told I most likely have a plantar plate tear. I have no deviation of my 3rd toe and truly only have pain w/ flexion. When I left his office he told me that if the toe splint he gave me allowed me to walk pain free then I could walk. I was wearing the splint and Dansko shoes and had minimal pain with walking. I was also given metetarsal pads which work to some degree as well. I do walk with a limp and have mild/moderate pain. I dont feel like I have received any real direction and would love to be an active runner again. After dealing with the continued pain and swelling I would like to develop a real treatment plan that will get me back to running and being active. I refuse to be sedentary : ) Thank you for your time in reviewing this and I would welcom any suggestions.

Dr. Runco
Dr. Runco 04-11-2015, 05:44

Hi Jen,
You are describing a condition generally called “metatarsalgia” which simply means pain in the metatarsal region. The diagnosis is poor because it does not describe which anatomical structure is actually causing the problem. The 5 most common diagnosis are;

1. Mortons Neuroma ( do you have “burning” into your toes)

2. Plantar Plate Sprain/Tear (most likely diagnosis. This is a severe sprain that is common)

3. Capsulitis (might be secondary to Plantar plate tear)

4. Bone Marrow Edema (it is possible you have bone marrow edema in your metatarsals)

5. Stress Fracture (very possible to be a stress FEATURE AND a Plantar Plate Sprain)

I am an expert in the diagnosis and treatment of these injuries Jen. I have seen hundreds if not thousands of people under-diagnosed or misdiagnosed, told to get shoes, inserts, incorrect metatarsal pads or even carbon fiber plates to put in your shoes by incompetent doctors, useless and needless surgeries for neuromas when in fact they have a plantar plate sprain/tear that eventually ruptures. If you feel the pain is getting worse that is a clear indicator that the damage to the bone, joint or ligament is worsening. I have a personal history with this injury Jen. I was suffering from metatarsal pain when the pain went from bad to worse instantly. An MRI revealed a torn plantar plate ligament. I narrowly avoided surgery.

Jen, as with any injury if a plantar plate tear/sprain is identified early the treatment to fix it is conservative and with a high success rate. The worse the injury the less likely conservative treatments will work and the person ends up undergoing a painful surgery often forever altering their skeleton. The fact that you have tried metatarsal pads and they are helpful is great but I will need a few more things in order to help you to my full ability.

1. email me the MRI report (if you have one)

2. Take pictures of your feet while looking down on them while sitting and then again standing. email those to me

3. mark the painful area and take a picture of it. email me those

4. if you have any boot, orthotics, metatarsal pads etc take a picture and email them to me

5. Call my office 858-268-8525 and leave a message with your full name and number you can be reached and time(s) you will answer to avoid phone tag. Also say you would like a phone consult.

6 fill out my new patient electronic intake form as soon as possible https://www.mychirotouch.com/patientintake/?clientid=SDRI0001

My office will call you back and schedule the 1/2 hour consult for us. tthe cost is $150 and afterwards I will email you a complete report with all of my recommendations.

Jen I have helped hundreds of people overcome and fix this problem without surgery using a protocol that has developed over the years by researching and implementing the things that work! If you would like to schedule a phone consultation you can by calling 858-268-8525.

mary scheifley 05-12-2015, 16:25

Hi -I also have pain on the bottom on my foot under my 2 second toe. My second toe is starting to look like a hammer toe. Went to a orthopedic foot Dr. he took x-rays push on it under my second toe and it was pretty painful. He told me I pretty much had a plantar tear. Prescribed me some naproxen and to come back in 6 weeks. This has been going on for 5 months now. He told me I’m pretty much looking at surgery in the near future. I do have a bunion on the same foot. I’ve seen the surgery and really do not want any part of it. Thank you Mary

Dr. Runco
Dr. Runco 07-12-2015, 07:24

Hi Mary,
There are many causes of plantar plate tears so I will give you the most common……from your inquiry it seems your bunion might be playing a part in this injury. In my opinion the doctor you are seeing is underserving you and dooming you to surgery. There are many other options. Please read the below and then follow my instructions.

1. The most common is transfer pain from abnormal weight bearing due to problems with the first toe. So problems like bunions or painful first metatarsal-phalangeal (1st MTP) joint can result in excessive weight bearing on the second metatarsal-phalangeal joint (2nd MTP) resulting in a slow and chronic tearing process. Initially the pain is referred to as metatarsalgia…which means “pain in the metatarsal”. The pain is due from repetitive micro-trauma to the 2nd MTP. This results in micro-tears that can even evade scrutiny by MRI! Over time the micro-tears and split and become grade 1-3 tears…..which is bad, bad ,bad. Bad because it results in pain, disability, no running, surgery or months in a walking boot unless you know how to treat it effectively….and I do.

2. While running or walking if you step on a sharp or hard rock in just the right way you can tear the 2nd plantar plate. In this case the pain is not present…then it is immediately following the incident. This is a trauma to the 2nd plantar plate and can result in the same dire set of circumstances.

3. In dancers that wear high heels which transfers all of their body weight onto the ball of their foot and 2nd MTP. Imagine a profession that might fit this description…wearing heels all the time and you will see lots of plantar plate injuries. Cocktail waitresses, dancers etc can get this.

4. People, especially women with high, rigid arches (Pes Cavus Rigidis) are prone to this. In this case the person bears all of their weight on the 1st and 2nd MTP’s due to the genetic anatomy of having high arches. Over time this can result in repetitive micro-trauma to the plantar plates.

5. Runners. Runners push off their 1st and 2nd MTP’s while in the “toe-off” portion of the gait cycle. Depending on the amount they pronate might depend on the amount of weight transfer from the first to the second plantar plate. Too much stress on the second plantar plate without adequate recovery time and a tear can result. The further you run also increases the risk which is why it is so prevalent in long distance runners.

Mary, as with any injury if a plantar plate tear/sprain is identified early the treatment to fix it is conservative and with a high success rate. The worse the injury the less likely conservative treatments will work and the person ends up undergoing a painful surgery often forever altering their skeleton. The fact that you have an MRI is helpful but I will need a few more things in order to help you to my full ability.

1. email me the MRI report

2. Take pictures of your feet while looking down on them while sitting and then again standing. email those to me

3. mark the painful area and take a picture of it. email me those

4. if you have any boot, orthotics, metatarsal pads etc take a picture and email them to me

5. Call my office 858-268-8525 and leave a message with your full name and number you can be reached and time(s) you will answer to avoid phone tag. Also say you would like a phone consult.

6 fill out my new patient electronic intake form as soon as possible https://www.mychirotouch.com/patientintake/?clientid=SDRI0001

My office will call you back and schedule the 1/2 hour consult for us. tthe cost is $150 and afterwards I will email you a complete report with all of my recommendations.

Mary I have helped hundreds of people overcome and fix this problem without surgery. If you would like to schedule a phone consultation you can by calling 858-268-8525.

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