Plantar Plate sprains are commonly misdiagnosed and mismanaged by doctors that are either inexperienced, incompetent or simply do not care to take the extra steps to help the patient.  Plantar Plate tears/sprains are most often misdiagnosed as Morton’s Neuroma which results in mismanagement of the condition and thus worsening of it.  This is problematic because the plantar plate is crucial to standing, walking and running.  If not detected early the condition can worsen resulting in foot deformity, intense pain, inability to exercise, depression and surgery.  For those of you who think surgery is not so bad please talk to patients who went in for “routine surgery” only to have it botched or worse contract an infection that resulted in amputation!  There is no such thing as routine surgery and in my opinion the specific surgery for  a plantar plate tear is barbaric.  Please read the letter below and if you or someone you know has this or a similar condition have them email me at info@sdri.net or call my office at 858-268-8525 to schedule an appointment.

Hey Doc I need your help!!!

Greetings from Hong Kong where I live (though I’m originally from the Boston area).

I found your site re plantar plate tear/sprain excellent and I’ll be calling your office on Monday for an appointment.  I’ve been getting the medical run around that you describe well for four months with regard to what I can see now from your website is a plantar plate tear/sprain:

damaged plantar plates result in pain and joint instability

So that you understand exactly what a sprain is Joe….a sprained ligament is another way of saying a torn ligament.  Sprains can be minimal, mild, moderate or severe.  Since the plantar plate is in your foot and is a weight bearing ligament it is unfortunate that you have been essentially making it worse for 4 months!

  •  The UK trained podiatrist I went to at the outset was lazy (you’re pronating.  Here’s an off the shelf orthotic.  Come back in six months)

I do not understand the podiatric obsession with the term “pronating” and how it relates to injury…..especially this injury.  I am sorry you encountered this lazy doctor.  In my experience there are lazy and incompetent people in every profession.  However, we expect more from people who are both highly trained and considered experts in specific areas……like a foot doctor.  

  •  I had orthotics custom made.  They came at least with a metatarsal pad which was helpful.  The orthotics were hard and not padded at the toe and generally seemed to destabilize both of my feet.    I stopped wearing them for this reason though I’ve kept using a metatarsal pad which does help but not sufficiently

  • If you have tried met-pads in the past and they were painful they were most likely not placed properly, too hard or too high.

  • The use of custom orthotics….with this condition is a tricky one.  The orthotic MUST be made to be comfortable AND effective.  Unfortunately most doctors do not seem to fully grasp this point and make orthotics that often are uncomfortable.  This means the patient will not wear them.  Making custom orthotics is not a science but an art.  It is good you stopped wearing them.  There are strategies for placing metatarsal pads in the correct location.  What is also not commonly known is that metatarsal pads come in all different heights, thickness, density and material…..this allows them to be made more comfortable.

  • met pads come in many heights, densities and sizes. If not sized correctly they can be uncomfortable and cause more pain

  • Then the physician I went to ordered an MRI thinking maybe I had Morton’s Neuroma and when the MRI showed it wasn’t that he gave me a cortisone shot and told me to come back in six weeks

OUCH!  This is a major problem.  Cortisone can actually cause damage to the plantar plate ligament because of its catabolic nature.  Cortisone can contribute to the degradation of the already damaged ligament and should not be injected into a damaged plantar plate.

When the MRI came back and did not show a Morton’s Neuroma this person blindly injected your foot with a destructive substance (cortisone) which may very well have contributed to the damage in your plantar plate.  Plus, telling you to leave and walk on it for 6 weeks…..cortisone is not magic!  Nor does it heal anything!  Cortisone is a catabolic hormone that decreases the inflammatory process by blocking certain enzyme pathways……which also blocks the ability of the ligament to repair.

 I’m now on to a sports medicine Podiatrist and he at least is the first to have told me that what I’ve got is a plantar plate tear.   From your website, I’m guessing it’s a bad level one tear or possible a level two tear.

Plantar Plates are very small and small tears are easy to miss even by excellent radiologist

You could ask another Radiologist to read your MRI again.  MRI’s often do not show plantar plate tears as the ligament is very small….yet so important.  Either way the MRI will not correct this condition….but don’t worry I have effective treatment strategies that will.

The guy I’m seeing now (sports-focused podiatrist) is advising I stick with the orthotics with a metatarsal pad I’ve got but to add some padding at the ball of the foot to off load weight on the second toe’s metatarsal area.   Also Ice and Advil.   And to his credit, he’s the first one to have me tape my second toe down.  I’ve been doing that for a couple of days now.

You will need to be in a boot most likely.  Like metatarsal pads, boots come in all kinds of designs.  I have personally tried 15 and know which one will work for you.  It will be important to transition you from the boot to regular shoes….maybe with the orthotics and met pads.  If necessary I can have you mail me your orthotics to be modified so that they can be COMFORTABLE.  Remember if they are not comfortable…..worse yet, if they hurt they are actually making matters worse.  Advil and ice are no good either.  Advil is an NSAID and anti-inflammatory drug and ice causes vasoconstriction of blood vessels.  In this case it is CRUCIAL that we get blood flow into the ligament.  I will be sending you strategies that will help you understand the physiology of ligament healing and how to use this to effectively heal your plantar plate ligament.  I know my recommendation of NO ICE and NO ADVIL flies in the face of what most doctors would recommend and what the internet professes but please trust me.  I have spent years studying this process and in this case ICE and NSAIDS are not helping and may contribute to the problem…the same way cortisone did.

Anyway, in reading your site I’m thinking I should go for the walking boot straightaway as it’s been four months of the other measures described above.   But I’d like to discuss this with you.   thus, as mentioned, I’ll call your office Monday to arrange an appointment.

At the appointment we will discuss many things.  I will also provide you via email a written, detailed report explaining exactly how you are going to heal your foot.  I have helped hundreds of people with this injury and will help you as well.  Ligaments are different than muscle so you will have to be patient.  There is also the fact that your injury has been present for so long and you have been walking on it.  Although this may delay the healing time it will not prevent it.  I look forward to helping you overcome this terrible condition.

If you want more information on Plantar Plate Tears/Sprains Click Here

If you want to purchase custom Metatarsal Pads Click Here

If you are suffering from a plantar plate injury or metatarsal pain and want to finally get rid of it email us at info@sdri.net or call 858-268-8525 to schedule an appointment.

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.