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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.

About Victor Runco

Dr. Runco is a U.S. Navy and Gulf War Veteran. Graduating as a Doctor of Chiropractic he began private practice in San Diego in 2000. 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 9 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 26-08-2013, 18:07

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

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 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 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://www.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 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 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 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 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 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 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.

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