This site definitely goes in-depth on what can cause a plantar plate injury, but I think what can separate this as an actual useful resource is telling you how you can actually heal from this type of injury. If you google just about anything on ‘plantar plate tear’ or ‘torn plantar plate’ you will find resources that sort of explain how it can happen, and follow that up with, ‘yeah so like rest it or get surgery!’ which honestly is not helpful at all!
So how do we rise above and aid in the healing process?? It begins with blood flow. Once you start to get below your calf, the rest of your leg and foot region is somewhat avascular, meaning it has little blood flow. Blood flow is what helps us heal. Blood carries oxygen and nutrients, which in turn help us turn over new tissues and ligaments and heal. When you are dealing with something like an Achilles or the ball of the foot region, there just is not much blood flow. This means it can take an extremely long time to heal injuries, and those injuries can go weeks or months without progressing at all.
So what do we do? Do we listen to the silly Surgery center’s website and just hack your foot open and start going to town on your ligaments and bones? Not yet! First, we have to try to rest for a lengthy period and promote an insane amount of blood flow. Luckily I know how to do this better than almost anyone!
You are gonna need some tools. The first couple of months you are going to want to hit the area with some ice. A chilly ice bath, this isn’t too painful will do the trick. A really smart way to do this is to ice for 5-15 minutes and then take your foot out and elevate it. The ice will constrict the blood vessels and lower the inflammation temporarily. Elevating it will just switch up the gravity allowing blood to run in the opposite direction more easily. This can also be done with an ice pack.
You can then graduate from Ice and elevation to Ice and Heat. The time intervals aren’t extremely important, but something like a 10 min ice, 10 min heat protocol would be excellent. For the heat, you can use a hot tub, a very warm bath, or some form of a heating pad. Switching off from ice and heat will constrict and open up your blood vessels and this REALLY promotes blood flow. The more consistent you can do this the better. Using this protocol for a couple of times a day for the first few months could be absolutely game-changing in your conservative treatment of a plantar plate tear and help you avoid a surgical procedure altogether.
Now what is a little confusing and frustrating about this is that it takes time, it takes a little set up of your heating and cooling tools and those generally have some prep involved, and you aren’t healing much at all for the first few weeks. It takes a very long time for the plantar plate ligaments to begin regrowing and laying down new fibrin and collagen. The first few weeks your body may just be reducing inflammation and closing up the tear that got created. Even once the tear begins to reconnect, the ligament is extremely weak and can be retorn very easily. The icing and heating procedure is helping the blood move oxygen and nutrients in so it can more quickly heal and lay down the new protective ligament. Sometimes your body is not fully receiving the signals that it needs to heal this area, so changing the state by heating, cooling and elevating we are also sending a signal to our brain that we need to be investigating this area.
Now if healing is taking an extremely long time and even with the icing and heating protocol is doesn’t seem like blood flow is being rushed into the area there is one more tactic you can employ. Nitroglycerin patches. unfortunately, you need a prescription to get these but these will definitely get some blood and oxygen into this area. These are often used with patients with heart conditions when their arteries aren’t pumping enough blood. They do have some science behind them that they do help oxygenate avascular areas. It is well known that these usually cause some gnarly headaches and migraines due to the nitrates. So ask your doctor what they think about the patches. It can really be a good idea to avoid surgery!
A couple of other blood flow related ideas that could help your recovery: Compression. Compression socks and sleeves for the impacted leg could improve circulation upstream and possibly have a positive impact on blood flow down river. I would probably go for a full toe to knee compression sock. Note that initially, they can cause a little swelling as more fluid will be circulating in this area. It is a very smart idea to elevate your legs up against a wall after wearing compression for the day to drain some of the excess fluid down. Too much fluid and blood pooling in an area for too long can be harmful.
Another good technique, which can be tricky in this situation, is exercise. Almost nothing promotes healthy fluid movement and blood flow like exercise. In this context, it will be difficult to exercise without further injuring your plantar plate. There are a few ways to get around this. You can bike while only using your heel, instead of your forefoot to press the pedals. You will have to be very mindful of this as you go. Getting in the pool to swim laps can be an exercise possibility as long as you make sure you do not press off the wall with the injured foot. Aqua jogging in the pool could also be super beneficial. With any exercise, you want to make sure you have let the tendon start to regrow and heal as much as possible before beginning such an endeavor. Early on in the injury, the added stress could actually set you back further, so be very cautious as you progress.
My last consideration would be your diet. Research healthy foods that promote circulation (like beets due to their high nitrate content). Being at your ideal weight also just puts less stress on your body and specifically the ball of your foot! and of course, make sure you’re hydrating! Any other blood flow tactics I missed? Let me know at plantarhealth@gmai.com