Weekend Doctor

By DR. THOMAS F. VAIL
Sports fans will remember Taylor Martinez, the senior quarterback for the Nebraska Huskers, who suffered a debilitating injury near the ball of his left foot in early November 2013 that left him out of the entire season.
He now is preparing for workouts in front of NFL scouts and coaches. He plans to be 100 percent for Nebraska’s pro-day in March.
Wrongly diagnosed as turf toe for many weeks, we can finally attach a medical term to Taylor Martinez’s foot injury that changed the course of Nebraska’s football season.
Dr. Mark Quist, a podiatrist of Carolina Foot and Ankle, diagnosed Martinez after the season. He described Taylor’s injury as a “plantar plate tear” of the second metatarsophalangeal joint, or “2nd MPJ,” in his left foot. In layman’s terms, this is a torn ligament in the foot.
His treatment has consisted of physical therapy, immobilization with a leg walker, injections, inserts and medications. He is no longer having pain plantarly, but the injury has left his 2nd MPJ in an elevated state, which can make the joint more vulnerable to capsulitis, tendinitis and metatarsalgia.
Even though Taylor Martinez suffered his tear with an injury, women over the age of 50 are frequently affected with ligament tears due to predisposing anatomic factors which include a congenitally long metatarsal, usually of the second toe; hallux valgus, a bunion; and joint hypermobility. Wearing shoes with high heels and/or a restrictive, narrow toe-box is a common contributor.
To diagnose a plantar plate tear, an x-ray and subsequent magnetic resonance imaging will be ordered by your podiatrist.
There are many bones and ligaments in your foot. A ligament is strong, flexible tissue that holds bones together.
When the foot lands awkwardly, some ligaments can stretch and tear. This is called a sprain. When the injury occurs to the middle part of the foot, this is called a foot sprain.
Most foot sprains happen due to sports or activities in which your body twists and pivots but your feet stay in place. Some of these sports include football, snowboarding and dance.
There are three levels of foot sprains.
• Minor: You have small tears in the ligaments.
• Moderate: You have large tears in the ligaments.
• Severe: The ligaments have completely torn from the bone.
Symptoms of a tear include pain, bruising and swelling. Pain is increased when walking or doing activity. Not being able to put weight on your foot usually happens with more severe injuries.
If it is painful to put weight on your foot, your doctor may give you a splint or crutches to use while your foot heals.
Most minor-to-moderate injuries will heal within two to four weeks. More severe injuries, such as injuries that need casting or splinting, will need a longer time to heal, up to six to eight weeks. The most serious injuries will need surgery to reduce the bone and allow the ligaments to heal. The healing process can be six to eight months.
The tough part of this injury is relieving the plantar pain, which, fortunately for Taylor, has completely resolved. The other types of pain associated with this injury can easily be relieved with toe straps/orthotics/pads and medications if needed.
You can begin light activity once the pain has decreased and the swelling has gone down. Slowly increase the amount of walking or activity each day.
There may be some soreness and stiffness when you walk. This will go away once the muscles and ligaments in your foot begin to stretch and strengthen.
Your physical therapist can give you exercises to help strengthen the muscles and ligaments in your foot. These exercises can also help prevent future injury.
Some tips to consider while healing:
• During activity, you should wear a stable and protective shoe.
• Custom orthotics in your shoes will help stabilize your foot and prevent further injury. These should be utilized only after swelling and pain have subsided.
• If you feel any sharp pain, stop the activity.
• Ice your foot after activity if you have any discomfort.
Talk to your podiatrist if you have suffered an injury to your foot or have increased swelling and bruising. It could indicate that you have a plantar plate tear.
Vail is with Advanced Footcare Clinic, Findlay. Questions for Blanchard Valley Health System experts may be sent to Weekend Doctor, The Courier, P.O. Box 609, Findlay, OH 45839.

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