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Thursday, June 28, 2018

Plantar Plate Tear 2nd MTJ: Email Advice

Dear Dr. Blake,

I was wondering if you could help me with answering some of my questions.  Firstly, I'll describe my situation.  Right before Christmas last year I stopped running due to extreme pain I endured in my last two runs. I struggled even to walk so I altered my gait to take pressure off the top part of my right foot. I can say that after 5 months I can now walk without pain but that is because I walk without using the front part of my foot and no longer using winter boots as it's warmer.  Now I am using Merrell vibram normal shoes which I find comfortable and I can detect which part of my foot that I can use. My second toe on both feet are longer than my big toe.

I have had an xray of my foot and an MRI.  The results of my MRI are as follows:

Irregularities seen in 2. Mtp-joint with a few very small subchondrale cysts with basis of prime phalanx. Implied hydrops and small periarticulare deposits dorsally. Suspected a small avulsion cortical fragment from basis of phalanx. Also markedly edema lateroplantar along course of lateral part of the plantar fascia and lateral collateralligaments so could be the state after avulsion of the plantar fascia with a small cortical fragment from the base of prime phalanx. No enhanced intermetarsal bursa, no Morton's nevrom. Normal flexor and extended tendons. Unremarkable sesame bone complex plantate for caput of 1.metatars. 
In 2. MTP-joint suspected sequelae after avulsion of the plantar fascia with a small torn cortical fragment from basolateral part of prime phalanx, and some synovitt changes and beginning small degenerative deposits
Dr. Blake's Comment: Yes, from you image above, the lateral aspect of the plantar plate is torn causing the 2nd toe to drift medially (toward the 1st toe). 

I have attached a photo of my foot, where toe drifting of the 2nd toe is quite apparent (please excuse the look of my sticky taped toes).

I will be meeting with a surgeon in October in discuss options for surgery.

In the meantime i have been recommended to use Hoka arachi runners to avoid pain and the ability to walk normally. I have tried a pair on and when I try to walk as normally as I remember I do not appear to have pain.  I was wondering, if I should purchase these shoes? If I do, the main reason would be so that I could resume running until my surgery. I tape my toe regularly.  I do pronate and have used orthotics in the past but not since my injury. My main question here is, will I cause more damage to my toe if I start running in the hoka arcachi runners , more so than if I wait until the surgery and resume running again then? 
Dr. Blake's comment: As long as you maintain the 0-2 pain level, you are okay to run. The joint has arthritis starting (all the bone cysts and periarticular deposits), but hopefully the surgeon will clean that out at the time of surgery along with fixing the ligament. There are so many types of surgery for this, it is hard to know. 
     So many of my patients wait and wait on surgery, some preventing it, and some having it eventually. The pain is from the joint not lining up and the joint lining gets irritated. This is the same as the knee cap tracking slightly off line laterally, and the pain is unbearable to some (called "runner's knee"). Normally, we can get rid of the pain overtime with icing routinely, rocker bottom shoes to avoid toe bend (like Hoka), Budin splints (in your case a single loop is opened up and put over the 2nd and 3rd toes together, maybe even taping the 2nd and 3rd toes in buddy taping fashion, and using an insert like an orthotic to off weight the bottom of the 2nd joint with accommodative padding (I have many examples in my blog). I have so many patients that have the surgery after years of these treatments, not because they are in pain and disabled, but they just get tired of the daily process and they hope the surgery makes them better. Normally it does. Good luck. Rich

I really appreciate your advice on this matter.

Thank you,

1 comment:

  1. Who would you recommend as the best podiatrist(s) for post tibial tendon dysfunction in the East Bay and Sacramento areas?


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.