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Sunday, December 15, 2019

Partial Tear Plantar Plate: Email Advice

Hello Dr.Blake,

My name is Allison (name changed due to witness protection), I would really appreciate your time to answer me on my problem. I’ve been in a lot of pain and recently I had an MRI and was told I have a partial tear of the 2nd plantar plate. I’ve been advised to wear a boot for 2 months. Unfortunately I’m still in a lot of pain and don’t feel there’s any progress.
I found you online and I was hopping you might have any suggestions on what I should do to help heal and not be in so much pain. Doctors say there’s no successful surgery. Do you have any recommendation or suggestions?

I would really appreciate it, Thank You!

Dr. Blake's comment: First of all, thank you for placing this in the blogger contact area of the blog. It is nice to meet you. Secondly, surgery is a common treatment for this condition with great results, so that is important to know. The treatment conservatively, and even post surgery, is based on figuring out the mechanics to protect and off weight, controlling the inflammation, and calming down the very sensitive nerves. The removable boot is a go-to for 2-3 months, but only if the pain in the boot is 0-2 on a scale to 10. That way you know that you are calming down the tissue. Sometimes the boot only puts more weight on the metatarsals increasing the pain. If this is the case, the boot has to be modified to off weight the sore area, or abandoned for bike shoes with embedded cleats, or just really stiff shoes with no bend. 
     You have to work for several years with budin splints or taping of the joint while you ice daily. If there is any swelling, you want to do contrast bathing each evening and do more elevation than you are doing. Massaging the area initially painlessly with hand lotion for 2 minutes twice daily can desensitize the tissue relaxing the nerves. PTs and acupuncturists know how to relax the tissues. Here are some videos that may be helpful. Good luck! Rich

Here is the concept of Budin Splint:

Here is a summary of plantar plate injury treatments:

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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.