Originally published on April 13, 2017.
I haven’t been able to run in eight months.
Eight. Long. Frustrating. Months.
Another thing I haven’t done during this time is a good job blogging about my partial plantar plate tear injury. I’ve given Coping with Injury tips, and given a few updates, and did some videos on YouTube, but I’ve yet to truly dig deep into the topic. Maybe because it’s been easier to mentally cope by writing about other topics. Plus there’s my fear of being a running blogger/vlogger who can’t run.
That, my friends, would suck.
The Joyful Miles blog, YouTube channel, podcast, and other sites provide general information about fitness, health, and related subjects based on our own experiences. We are not doctors, registered dietitians, or fitness experts. Our content is not intended and should not be construed as medical advice. When it comes to your health and fitness, do your research and consult your doctor.
But after doing many google searches, I’ve only found a few blog posts about this bugger of a rare injury. I’m doing a disservice to others who are trying to find information about plantar plate tears, (PPT,) by not writing about my experience.
So here goes. In this post, I’m going to give the full scoop and then follow up with tips on how you can prevent injuries and more updates.
What is a Partial Plantar Plate Tear?
The plantar plate is a strong ligament on the bottom of the foot that attaches your toes from your metatarsal joint to the long bones at the base of your toes, keeping your toes in place instead of splaying. Aka, a very important ligament if you don’t want hammertoes.
PP tears are more common in middle-aged women, (10:1,) especially those who over-pronate or roll their foot inward. (Hello, that’s me.) There are three different stages: Stage One being a sprain, Stage Two, (again, that’s me,) a partial tear that can be treated with conservative measures, and Stage Three, where the ligament has torn completely from the joint and surgery is the only option.
The symptoms can include:
- Pain in the ball of your foot.
- The feeling of walking on the bones of your foot or like there’s a pebble in your shoe.
- Your toe starts to shift upward and cross toward your big toe.
- Swelling and redness on the foot above the second toe.
How did it happen?
I’ve been sidelined with a partial PPT in my second metatarsal joint since running the Disneyland Half in September. The cause is unknown since I didn’t have any distinct moment of trauma but my unwise decision to switch to a less stabilizing shoe, (Asics Kayano to Asic GT-2000,) too close to the half could have been a major factor.
NEVER switch shoe styles before a race!
Once back home, the balls of both my feet were sore, but it felt more from walking long hours in the parks rather than from an injury. Still, I took a week off from running before getting on the treadmill for an easy five miles. There was minimal pain at first, but it subsided after a couple of miles. Same thing a week later when I tried another easy run on the treadmill. An ache at first that soon dissipated. This time, however, there was substantial more pain in my left foot afterward, telling me something was wrong.
With the Wine and Dine Half Marathon on my horizon, I knew I needed to see a doctor. Like, fast. I tried making an appointment with a podiatrist I’ve seen before, but his schedule was booked for an entire month. So I tried several others, both podiatrists and orthopedic surgeons, and booked with the first who could see me that week.
I sat nervously in the waiting room on September 20th with that question all of us runners dread swirling in my head. Will I run again?
The doctor seemed sympathetic to my situation. My X-rays showed no broken bones or fractures, although some hairline stress fractures won’t show up on an X-ray. So he diagnosed either a stress fracture or sprain and recommended I return after six weeks of no running if the pain is still there.
“Will I run again?”
But the Chicago Marathon was now definitely out, which was upsetting since I was to run it with my friend and Princess Half pal, Kelly. Instead, my husband took us to our beach house that weekend where I drank too much beer, ate an entire pizza by myself, and wrote a very depressing blog post.
TIP: never blog when you are depressed, stuffed, and slightly buzzed.
Seeing as how there was no improvement with my injury after six weeks, I went back to the doctor on October 13th for another round of X-rays.
This time, he said it was possible I had a Freiburg Infraction due to my second metatarsal joint appearing flattened. A Freiburg what???
Freiberg disease, also known as a Freiberg infraction, is a form of avascular necrosis in the metatarsal. It generally develops in the second metatarsal, but can occur in any metatarsal. (Thank you, Wikipedia.)
An MRI would be the only way for a true diagnosis, however. My husband and I are self-employed with a very high insurance deductible, so we’d have to pay for this out of pocket. After relating this to him, he said I could skip it, for now, seeing as how conservative treatments for both a stress fracture and Freiburg Infraction are the same: rest. So I decided to wait for now.
HUGE mistake. Always, ALWAYS do whatever it takes to get an accurate diagnosis! (Especially after I later discovered it would only cost me $199.00 after our insurance company absorbed most of the cost.)
The doctor then recommended wearing a stiff-soled insert and metatarsal pad. He also said a cortisone shot could ease the pain, but I refused. THANK GOD. While this can be helpful with other foot conditions, it can cause a ligament rupture for those with a PPT, sending you straight to the operating table. So my biggest tip today is to NEVER get a cortisone injection unless your diagnosis is firm. Just don’t!
I then asked about wearing a walking boot. Would it help? He said it couldn’t hurt and had me fitted for one that I wore for six weeks. As for walking the Wine and Dine Half Marathon, I had clearance if I took it easy.
“But will I run again?”
After my doctor appointment, I immediately jumped online and researched Freiburg Infractions in hopes it wouldn’t sideline my running career for good.
The prognosis? Not great.
Most runners with this injury never fully returned to their original form and many required surgery.
I did not take this well.
I was certain this was my injury, seeing as how the symptoms are very similar to a PPT. And in retrospect, maybe that’s why I foolishly decided to walk the Wine and Dine Half Marathon. Because if my runDisney career was soon going to come to an end, I was going to go out big.
Fast forward a couple of weeks. After still no improvement, I decided to get the MRI, something I should have done right from the get-go. There was an appointment available the day before Thanksgiving at 6:00 am so I grabbed it. At 3:00 pm that same day, I got a call from my doctor’s assistant.
Indications of an injury that resulted in a tear of the attachment of the second plantar plate at the base of my second toe, as well as signs of bone marrow edema.
Aka, a partial plantar plate tear and inflammation and absolutely no Freiburg Infraction. I immediately made another appointment with my doctor for that Friday and then spent the rest of my day googling PPTs and gathering as much information as possible from those who had or have the same injury.
The results were all over the place.
Some runners healed in months. Some years.
Some had surgery. Some of the results were good. Some of them led to even more pain.
In general, a PPT is one bugger of a slow-healing injury.
Still, the prognosis is much better than a Freiburg Infraction so I was grateful, despite having to pull out of the WDW Marathon Weekend. And for the moment, I managed to pull myself out of the Deep Dark as I explained in this blog post.
Let’s fast forward.
During my previous appointment, my doctor said custom orthotics would be a good next step and said he’d give me a referral before leaving. We both forgot about it, however, so I left a message with his office in hopes of it being forwarded to a certified orthotist, (a healthcare professional who makes and fits braces, splints, custom orthotics, etc.) No reply. A week later, I left another message. His assistant returned it a few days later, saying that she was confused about my initial request. She then said I could pick up the referral, but after speaking with my doctor, she relayed his belief that if I wasn’t feeling better by now, surgery was my only option.
Seriously? Just like that? Even though I had no signs of toe shifting and very little pain?
Yeah. No. This went up me sideways.
I was starting to believe this doctor was only truly interested in cases that required surgery, so I sought out a second opinion. On January 20th, I saw my second doctor who thoroughly examined my foot and reviewed my MRI. Due to my ligament was still being intact with no inflammation, he did not think surgery was necessary at all.
“But will I run again?”
“Oh yeah, most likely.”
He also recommended things my first doctor never did, such as taping my second toe down to relieve the pressure on the torn ligament as well as wearing a rocker-sole shoe such as the Hoka One One. As for custom orthotics, he recommended waiting to see how the taping went, but he could give me a prescription then if I wanted one.
I should have said yes, please, give me the prescription. Honestly, I don’t know why I didn’t. I’m still pissed at myself for this one.
And I was pissed at my first doctor for never suggesting taping or rocker-soled shoes, seeing as how it’s usually always the first step in conservative treatments for a PPT. And I was pissed at myself for not discovering this for myself and being assertive during my past doctor appointments.
Pissed, pissed, pissed.
But I was also extremely thankful for getting clearance to walk each race during the Princess Half Marathon. And for the first time since October, I started to believe that yes, I WILL RUN AGAIN, even though it might take several more months.
Then I saw my doctor again on March 16th for another round of X-rays.
Long story short, considering there has been no improvement since our last visit, he said there’s nothing more he can do.
He did recommend I try custom orthotics now and said he’d forward a prescription to an office in Towson, Maryland, about a 45-minute drive for me. (According to his assistant, later on, the office would contact me to make an appointment.) Before leaving, however, the doctor looked at my X-ray again and expressed concern about my second toe possibly drifting, (aka, I’m screwed,) but then again … it could just be naturally crooked. The only way to know for sure would be to take X-rays of my right foot.
Now. Had I been smart, I would have said, “Okay, let’s take the X-rays now,” rather than have this fear haunting me for the next few weeks.
Or better yet. I could have said, “Hey, I have my first X-rays on my phone. Would it help to compare it to that one?”
And how about, “There’s a great orthotist right here in town who can do my custom inserts. Can I just go there rather than drive for 45 minutes?”
But no. I wasn’t thinking straight. His nothing more we can do comment put me in a frenzy, causing me to forget about other options I’ve read about online. What about shock wave therapy? Or PRP (platelet-rich plasma) therapy? Or an ultrasound? Dry pin therapy?
Tip: ALWAYS go to your doctor’s armed with a list and a plan in case your mind goes blank.
Instead, I sat in the waiting room afterward, beating myself up mentally for being so unprepared and unassertive. I also made a quick collage on my phone comparing the two X-rays that the receptionist emailed him later.
I never heard back, not that I really expected to.
And I never heard from the orthotist office that he recommended. They never called to make an appointment so, after one week, I called his office and left a message. No reply. Three days later, I called and spoke with the receptionist instead, who forwarded me to my doctor’s assistant to leave another voice mail.
Meanwhile, I called the certified orthotist in town who said he could see me that very day if I was able to get my prescription.
Thankfully, my doctor’s assistant called me back an hour later and was more than willing to have it waiting for me at the front desk, no fight was necessary. (When I asked her about PRP and other therapies, she said in her years with this doctor, he has only prescribed such treatments one time and would most likely not recommend them.)
Now. David, my orthotist?
I loved him.
He was very knowledgeable about my injury and proved that getting custom orthotics should have been one of my first steps, after diagnosing me as both an over-pronator and there’s also something funky going on with my heels … I didn’t think to write down the word he used.
And dang it! I didn’t take a picture of my foot mold!
David said I will most likely need custom orthotics for running for the rest of my life as well as continuing to use the carbon-graphite fiber insole. And there’s a chance that I’ll always have pain when I run.
Plus a chance I’ll need surgery after all.
There are just no guarantees with this persnickety injury. If I do? There’s only one surgeon who will do it, a doctor in the same office as David. (And one I tried to make an appointment with but he only sees patients who are ready for surgery, he’s that good.) David recommended I trr to make an appointment again after wearing the custom orthotics for a few weeks, just to get a third opinion.
Where I’m at now
In the core of my soul… I don’t think I need surgery. My gut says I will heal and run again, maybe by the summer. There’s hardly any pain in my foot now, even when I press down trying to find a ‘hot spot,’ and my second toe does not appear to be shifting, splaying, or lifting of the ground.
One thing is certain, however.
I need to learn how to walk again.
I’ve been limping and favoring my metatarsal joint for so long that I now walk with my foot pointed out and weight rolled to my third and fourth metatarsal joints. I’m trying to correct this and hope my custom orthotics will help, once they are in. (It’s been two weeks so I’m calling today, hello, Ms. Assertive.) If not, my next step might be seeing a physical therapist and using a zero-gravity treadmill to ease into running slowly.
But that’s a conversation for a different day, seeing as how I’m not there yet.
I will be, though.
I don’t know when but it will happen. I will Recover. Run. Rejoice. And in time to be trained and ready to run the 2018 WDW Dopey Challenge next January!
Thanks for reading my VERY long update. Take care, be safe, and happy running!