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My Partial Plantar Plate Tear Injury: The Full Scoop | Recover, Run, Rejoice

My Partial Plantar Plate Tear Injury: The Full Scoop

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, talked about Walking a Race in a Boot, and given a few updates and did some videos on YouTube, but I’ve yet to truly dig deep in 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. 

My Partial Plantar Plate Tear: The Full Scoop

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 your toes, keeping your toes in place instead of splaying. Aka, a very important ligament if you don’t want hammer toes.

Image from Infinity Foot and Ankle Institute

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 nervous 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?”

“Most likely.”

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 your 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 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?”

“It’s possible.”

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.

One thing I did purchase that has been helpful is a carbon graphite fiber insole from My Foot Shop as well as some gel metatarsal pads, both of which I still use.

Fast forward a couple 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 6:00am so I grabbed it. At 3:00pm that same day, I got a call from my doctor’s assistant.

The diagnosis?

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. 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 case 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.”

Thank God.

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 orthodics, 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 thought 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 orthodics 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 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 afterwards, 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 orthodist 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 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 orthodics 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’s 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 me trying to make an appointment again after wearing the custom orthodics for a few weeks, just to get a third opinion.

Where I’m at now

In the core of my sole … 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 orthodics 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.

Until then, I will do a better job documenting my recovery with bi-monthly updates for those of you who are diagnoses with the same injury. Before wrapping up this one, however, I want to mention some other things I’ve been doing in an effort to heal:

  • I’m still taping down my second toe as well as taping it to my third toe just as a preventative to keep it from drifting.
  • I’ve been taking a Turmeric supplement daily since it can help with soft tissue damage.
  • I’m also taking Rhos Tox and Horsetail, both of which can be helpful for ligament damage.
  • I tried using this BSFT Inferno Wrap after reading in this very long forum thread how it’s been helpful for some, but I have mixed feelings about it and couldn’t be sure if it was helping or hurting, so I’ve discontinued using it.

Thanks for reading my VERY long update. Take care, be safe, and happy running!

About the author: Laura is a writer, runner, reader, runDisney addict, blogger, vlogger, mom of two college boys, excellent chili maker, and obsessive list keeper. She still thinks Spice World was an awesome movie and feels no shame about that.

{ 21 comments… add one }
  • Melanie April 13, 2017, 12:01 pm

    Laura, I am sorry to read about your injury. Hopefully the orthotics will help. I wear them for other reasons and they are great. So if you have to wear them for the rest of your running career just do it. Make sure you break them in. Wear them 2 hours the first day, 3 hours the next day, 4 the next etc.. sometimes they forget to tell you and you can feel it in your knees. Also my guess is your feet will ache. Both feet, your entire foot. This is common b/c it is shifting your entire foot and how it strikes the ground when walking/running. Also I am surprised no one has recommended PT. Not to cure the tear but to help strengthen/stretch the muscles in your leg/foot. Which will help with your limp. I am a PT so I am bias but I am surprised. Please push for this for yourself. You mentioned that your deductible is high so just explain to the PT office you can only come a few times to get a good home program. Good luck and stay positive!

    • Laura Bowers April 25, 2017, 7:58 am

      Thanks, Melanie!! I just posted today about my new orthodics … that I totally hate. πŸ˜‰ The orthodist did give me a program to break them in, but I’m going back tomorrow to get the one trimmed and then I’ll try again with them. ShaeLee also gave me a heads up on the new Hoka Ora recovery sliders that I can wear the orthodics in, so I’m really excited about them! Ordering soon.

      My orthodist did recommend ‘stride and strike’ PT and another person who went through a PPT also said using a zero-gravity treadmill helped a lot. I’m waiting to see how it goes with the orthodics and maybe get a second MRI before starting.

      Hope you had a great time at SW Dark Side!! πŸ™‚

  • ShaeLee April 13, 2017, 12:38 pm

    Love your determination to find a solution and to keep in top of your care. I have a question; have you ever considered that treadmill use may be harming your recovery? I say this because though it has its uses (bad-weather training, etc), the pull of the belt isn’t normal to running. I get what I compare to “turf toe” when I do a lot of running on the treadmill and Shalane Flanagan actually pulled out of Boston due to a back unjustly that she sustained while training on the treadmill. Do you have a school track around you? I’m not a fan of trail running because I have to watch for the rocks and roots but that might also help.

    • Laura Bowers April 25, 2017, 8:02 am

      Hmm, that’s something I definitely need to look into, since I normally do a lot of running on the treadmill. I’ve been sticking with the stationary bike or biking outside during the past seven months, but I’ll remember this for when I can start again. And yeah, I think my days of trail running are out. πŸ™ And I’m ordering those Hoka sliders today! Thanks again for the heads up! πŸ™‚

  • Lesley April 13, 2017, 2:44 pm

    I was wearing the first GT-2000 style when I got ITBS, and when I went to the running store, they found the tread wasn’t where it should’ve been. I keep thinking “what if” I had known about the changes in ASICS and got fitted properly. I just assumed since I was wearing the 2100 series, the new GT-2000s would work fine. I won’t even wear ASICS now because they keep changing their models.

    • Laura Bowers April 25, 2017, 8:05 am

      Yeah, I’m a Hoka girl from now on, not that I have much choice in the matter. πŸ˜‰ And I won’t go by the opinion of a running store when it comes to shoes. I’ll do my research first! Had I done so, then maybe I wouldn’t be in this pickle. #couldawouldashoulda But yes, that’s great advice for everybody! Thanks! πŸ™‚

  • WendyTaking the Long Way Home April 13, 2017, 8:53 pm

    I’m so so sorry to hear this. People always tell runners they’re going to ruin their knees, but it’s the feet that are the problem! It’s hard to be patient and wait for things to get better too. Some things I’ve learned: podiatrist are really variable in how they treat foot issues, I’m not a fan of custom orthotics (i use Spenco soft orthotics), and warming up my feet in the morning on a heat pad really helps.

    I’ve had a lot of issues with my feet. Right now I’m testing out some PF flip flops that I’ll be reviewing next week on the blog. I’m liking them a lot…

    • Laura Bowers April 25, 2017, 8:38 am

      Thanks so much, Wendy! My custom orthotics did come in …. and I hate them. πŸ™ I’m getting them trimmed tomorrow to see if that helps and will give them another shot, but wow. The Spenco’s are sounding pretty good right now! And I’ll try your tip of warming up my feet … they’re always cold anyway and it sounds really nice. πŸ˜‰

  • Karen April 18, 2017, 1:53 pm

    I am so sorry to hear about all of your frustrations and the back and forth circles you’ve had to go in! Glad to hear the foot is feeling better and on the mend!

    • Laura Bowers April 25, 2017, 8:40 am

      Thanks, Karen! I know God always has a reason for things that happen so I’m hoping this is all just a long, long lesson learned that others can benefit from. πŸ˜‰

  • Kristen K. April 24, 2017, 10:02 pm

    I’m following along with your story Laura, stay strong, and take care of yourself! I know how hard having to slow down is, but can totally do what you need to in order to heal.

    • Laura Bowers April 25, 2017, 9:07 am

      Thanks so much, Kristen, I appreciate it! πŸ™‚

  • Ashley Wilson July 28, 2017, 12:32 pm

    Hi there. I randomly came across your blog and I just wanted to recommend reaching out to Dr. Richard Blake – http://www.drblakeshealingsole.com/ for advice on your injury. His blog is FULL of info and he will happily answer questions via email, give advice and even look at your MRI if you mail it to him. It’s always nice to get another opinion especially from such a wonderful, caring and knowledgeable doctor.

    • Laura Bowers August 2, 2017, 4:21 pm

      Thanks so much for the lovely message! I’ll keep Dr. Blake in mind. πŸ™‚

  • Karen September 6, 2017, 4:05 am

    Found your blog article whilst googling about PPT’s. Will be following your recovery with interest. I was diagnosed with a PPT about 6 months ago and am desperate to get back to running. In fact to walk without limping would be nice! I have been a distance runner for a number of years and have always felt indestructible – never struggling with injuries until this. I changed my shoes from Brooks Ariels – very supportive shoes to Brooks Vapor as it was suggested that perhaps I did not need as much support. Now I am wondering if this lead to the injury or perhaps I am just falling apart now that I have turned 50😧. I was given orthotics by the podiatrist, shown how to tape my toes and told to ease back into running but as soon as I up the distance, my foot becomes painful and I am back to limping. Just today, the podiatrist suggested I try Hokas – so think I will give them a go. Hope you are making a steady recovery – would love to see an update o your progress.

    • Laura Bowers October 17, 2017, 11:18 am

      Hi, Karen, sorry for my late response, but I’m hoping the Hokas are working out better for you! I wear the Hoka Arahi’s and they’re great. I’ve also heard that taking calcium, turmeric, and beet root are also helpful, so I’m taking them now. I still have pain in my left foot, but my doctor believes it’s from my calves being so stiff. I’m also now having pain in my right foot and have an appointment scheduled for next Tuesday. I miss the days when I had healthy feet!

  • Eileen November 29, 2017, 3:50 am

    Thank you Laura. I am in NY and was diagnosed with a PPT in April. Spent 12 weeks in a boot. Believe it or not, it happened because I used the “press to release feature” of my new Bosch oven warming drawer. Am going through much the same as you. Have to relearn how to walk. Tend to walk with my toes of injured foot curled downward to protect it, favoring by leaning foot to put pressure on 4th and 5th toes. Have seen 3 podiatrists and an orthopedic surgeon in NYC, HSS. I use a metatarsal pad daily which offloads pressure at the injury. Have not been taping toe, but am considering resuming that after your article, because the toe is not migrating upward and I want to keep it that way. My podiatrist says he doesn’t think the carbon graphite insole will be tolerable for me. But I feel I need the rigidity to be able to walk without having to stiffen my foot for protection. Is insole uncomfortable or hard on your hip or knees? I was a speed walker and yoga person. Painful losses. I too am hopeful and determined. We need to get more information out about this injury. Your post helps and I will follow your progress and keep you and others updated on mine. I am thinking of starting a support group in my area. There are more and more of us because MRI is now diagnosing accurately. Thanks again for speaking out on this important but little known injury.

  • Sam Harrison January 23, 2018, 7:21 pm

    My case sounds a lot like yours. I’m an avid athlete and very frustrated with the planter plate injury that I’ve had since May. I had an x-ray and an MRI which showed the tear. I’ve tried everything from cortisone shots, physical therapy, anti-inflammatory medication, off the shelf orthotics to the boot and metatarsel pads. Nothing has relieved the pain totally. The only shoe that helps is Hoka running shoe. My current orthopedist at HSS has told me repeatedly that the pain should subside over time and that surgery is not warranted. When you look at my two feet they both look the same. I don’t have a visible problem, however my third toe really hurts. The only thing I haven’t tried is a custom orthotic which is treatment of choice by the orthopedist at HSS. Previously I went to another orthopedist and two podiatrists. Laura, how did you make out with your custom orthotics? Any one have any other suggestions?

  • Sophie Smith February 1, 2018, 5:50 pm

    Hi Laura,
    I’m so happy I stumbled across your blog whilst research appropriate footwear for ppt. I’ve had it for about a year now, I’m a runner like you (ex runner for now!!) I spent April – October 2017 barely being able to walk with or with shoes. All doctors said it was inflamed metatarsals and to rest. Yawn. I got my custom insoles fitted Sept 1st and by October I could finally walk pain free whilst wearing them. They are now a part of me and my feet and I can’t cope without them. I can finally start walking bare foot again around the house which is so lovely! I’ve just started yoga as well which ex ppt’ers swear by. My yoga teacher had it 10 years ago. I do it at least 3 times a week and I should start seeing results in 1 month. Fingers crossed.
    I hoope yours is doing well now and you’re back running! Hopefully I can be too by the end of the year πŸ™‚
    PS. I’ve had shock wave therapy – it really does work!!!

  • Dana March 18, 2018, 9:44 am

    I am now 8 months out from PPT been wearing custom orthotics and thought things were going well, but now all of a sudden feel like I am
    feeling my foot again even at night. Starting to get depressed again as summer is approaching and can’t imagine another summer wearing socks and sneakers all of the time. Also becoming an issue for work as I have been wearing sneakers for 8 months and really would like to wear other shoes. Do you have any other shoes you can recommend for summer or comfy for work but not totally the sneaker commuter look?! Do you still have pain? Looks like you are doing much better if you just did the Disney marathon. Just trying to search for something to get over the hump and move on from this nagging injury.

  • Gloria March 20, 2018, 12:31 pm

    Hi Laura,
    Today I found your notes about PPT and feel very much identified with you.
    I rolled over the stairs in flipflops one day I was running late to my karate practice and my left big toe took the worst part. Its been 6w since then and only now after 2Xray and 3 Doctors,the MRI got the diagnosis. After trying several NSAIDs, and pain killers. Im now resting at home, using marigold tablets, lidocain patchs, infrared and hot and cold therapy to help the swollen feeling in my foot as well as trying to do the first β€œsteps” Of walking with the help of crutches and hoping in 3w on my next Dr check up Im ready to walk by myself again or at least upgrade to a cane haha. I feel your frustration and think i totally need a bracelet like yours haha. Im not giving up on this!

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