Plantar Plate Tear, Cortisone,Ice and Ibuprofen

/, Running Injuries, Sports Injuries/Plantar Plate Tear, Cortisone,Ice and Ibuprofen

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.

 

By |2018-05-31T15:28:14+00:00January 21st, 2015|Foot/Heel Injuries, Running Injuries, Sports Injuries|10 Comments

About the Author:

Dr. Bruce B. Allen, DC, CKT is a graduate of Southern California University of Health Sciences, (LACC). Prior to becoming a Doctor of Chiropractic Medicine, he worked as a Physiotherapist and Personal Trainer throughout San Diego. Dr. Allen received his Bachelor of Science in Kinesiology (Human Movement & Sports Science) specializing in Kinesiotherapy from San Diego State University. In addition, Dr. Allen has had extensive experience working with patients for post-operative and sports injury rehabilitation in a local physical therapy clinic here in San Diego.

10 Comments

  1. Matt July 10, 2017 at 2:06 am - Reply

    This is the most interesting article I’ve read concerning the pain in the front of both my feet. In 2014 I over-flexed the toes on both feet. Soon after I began to feel pain in the front pads of both feet. I also gradually began to feel stiffness under toes when clenching them. Initially GP said buy orthotic from pharmacy. Later I was given X-rays and no fracture was found. GP said, Morton’s Neuroma and would inject both feet with steroid. I refused and went to podiatrist. He used ultrasound and told me I had neuroma 2nd toe, both feet. First he did gait analysis and made me run on treadmill, which made pain worse. He gave me custom orthotics, which were later shortened when another part of my forefoot began to feel painful. He gave me diagnostic injections, which made no difference to pain. He did cryosurgery on right foot. It failed. He then gave steroid injection in right foot. It failed. He then did cryo again. It failed. My trust had evaporated. I returned to GP who sent me for MRI. Radiologist diagnosed MN in both feet. I was sent to orthopaedic centre to see specialist foot surgeon. He did more X-rays and examined feet. He said previous diagnosis was wrong and problem was in MTP joint, second toe, both feet. He gave me stretching exercises and an off the shelf orthotic with metatarsal pad. It didn’t work. He then gave me another MRI. He stated no MN found, previous diagnosis was wrong and couldn’t see structural damage. He next injected steroids into MTP joint 2nd toe, both feet. It didn’t work and he discharged me. Told me to just carry on stretching calf muscle both legs. I have now had worsening pain for over three years with confusing opinions from doctors and no idea what to do or what exactly is wrong. I’m in UK so can’t come to see you, but would if I could.

    • Dr. Allen July 11, 2017 at 5:27 am - Reply

      Hi Matt,
      There are a few conditions you could be suffering from such as with a plantar plate tear injury the most likely. This condition is often missed on MRI but you are describing the symptoms perfectly. I have helped hundreds of patients around the world recover from this painful condition and would like to help you as well. If you would like my help and expertise please fill out this new patient form and respond to my email.
      If you send me a chronological history
      anything you tried that helped or hurt
      any MRI’s, X-rays etc

  2. Matt July 11, 2017 at 6:02 am - Reply

    Hi Dr Allen
    I’m very grateful for your reply and offer. I will sort out the chronology and try to get the scans and reports from the docs and send you the form as soon as I’ve got the info. Many thanks
    Matt

  3. Matt July 17, 2017 at 4:30 pm - Reply

    Hi Dr Allen
    Thank you very much for the consultation and the help and advice you have given me. All my emails were responded to very efficiently. I would recommend you and the SDRI to anyone. After all the drs I have seen in the last three years, I now feel very positive that your advice and the proposed treatment is the right path for healing the injury.
    Matt

  4. Janine Netto July 26, 2017 at 7:38 am - Reply

    Hello
    My name is Janine, I just came across your page and have a ton of questions. I am currently SUFFERING with planter plate issues in both feet. I have had an MRI of the left foot and it sowed a tear, surgery has been suggested but I have been putting it off for over 6 moths now. Recently my right foot has started with the same pain and it is unbearable. I had both bunions removed in my 20’s ( I am now 42) and the thought of foot surgery again is unthinkable. I am wondering how I go about setting up a phone consult? Thanks so much in advance…I am getting desperate!
    Janine

    • Dr. Allen July 26, 2017 at 9:10 am - Reply

      Hi Janine,
      You are suffering from a transfer injury to the metatarsal joints which is common for bunion surgery sufferers. I can and would like to help you. Here is how we set up a consultation. You send me the copy of your MRI report and a chronological history of your condition, the treatments tried and any other necessary information relevant to your condition. After our consultation I will send you a written treatment plan with specific instructions so that you may go to a doctor or therapist of your choice to implement it if you choose not to have it at SDRI.

  5. Toni August 8, 2017 at 11:57 am - Reply

    I have a plantar plate tear in my left foot small toe and right foot big toe. getting u/s this week to confirm diagnosis. My Doc says absolutely no to PP surgery, but has not given me any treatment suggestions other than taping the toes. I feel the tears are not small as my big toe drifts slightly and has decreased flexion strength and my small toe drifts with decreased strength. What are the conservative treatment methods? Thank you so much

    • Dr. Allen August 9, 2017 at 5:16 am - Reply

      It is unfortunate that you doctor…for some reason….has not provided you with an effective conservative strategy.
      I have a hard time believing you have 3 plantar plate tears….mainly due to the first and last metatarsal being the least common for that to occur.
      In order to provide you with an effective treatment strategy I would need much more information regarding
      1. the history of your injury
      2. your current symptoms
      3. your lifestyle and what you do for work (for example working on your feet can make this challenging to heal)
      If you want to provide me with all of this information email it to me at info@sdri.net After reviewing it we can set up a consultation (assuming you want to come to San Diego). The cost is $237 and afterwards I can provide you with an effective conservative treatment strategy, written report and any necessary home video tutorials that will prove useful to you.

  6. Hussain November 21, 2017 at 10:16 am - Reply

    Dear Dr. Allen
    Greetings,

    After reading some article about planter plate injury looks like I went through the same process and injury got worsen. How can you advice me for my case.I have MRI with the report.

    • Dr. Runco November 21, 2017 at 12:06 pm - Reply

      Hi Hussain,
      send me the MRI report. Drrunco@sdri.net I will review it and send you the necessary information if you would like my help. Plantar plate tears/sprains are serious conditions that can cause loss of function in your foot and a lot of pain. I have helped hundreds of patients correct this condition without surgery.

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