Plantar-Plate Disruptions: “The Severe Turf-Toe Injury.” Three Cases in Contact Athletes

Abstract

Objective: To present 3 cases of plantar-plate rupture and turf-toe injury in contact athletes at 1 university and to discuss appropriate diagnosis and treatment algorithms for each case.Background: Turf toe is a common injury in athletes participating in outdoor cutting sports. However, it has been used as an umbrella term to describe many different injuries of the great toe. In some cases, the injury can be so severe that the plantar plate and sesamoid apparatus may be ruptured. These patients may be better managed with surgery than with traditional nonoperative interventions.Differential Diagnosis: Turf toe, plantar-plate disruption, sesamoid fracture.Treatment: For stable injuries in which the plantar plate is not completely disrupted, nonoperative treatment with casting or a stiff-soled shoe, gradual weight bearing, and rehabilitation is the best practice. Unstable injuries require surgical intervention and plantar-plate repair.Uniqueness: Turf toe and injury to the first metatarsophalangeal joint are relatively common injuries in athletes, but few researchers have detailed the operative and nonoperative treatments of plantar-plate disruption in these patients. We examine 3 cases that occurred over 4 seasons on a collegiate football team.Conclusions: Turf toe represents a wide array of pathologic conditions involving the first metatarsophalangeal joint. Stress and instability testing are key components to assess in determining whether surgical intervention is warranted to restore optimal function. Stiffer-soled shoes or shoes with steel-plate insertions may help to prevent these injuries and are useful tools for protection during the rehabilitation period.Key Words: metatarsophalangeal joint, great toe, football players T urf toe is a common injury in athletes participating in outdoor cutting sports. Clanton and Ford 1 reported that injury to the foot was the third leading cause of missed athletic participation. Damage to the metatarsophalangeal joint (MTPJ) represents a large percentage of those injuries. However, since Bowers and Martin 2 coined the term turf toe, it has been a poorly studied topic of substantial controversy. They originally described turf toe as a sprain to the first MTPJ, but in many instances, the injury has been attributed incorrectly to various pathologic conditions involving the first ray.2 Turf toe historically has been managed nonoperatively with a stiff-soled shoe or short walking boot. Yet in severe cases, the plantar plate may be ruptured and disrupted. These injuries are easy to overlook on physical examination. Therefore, the purpose of our study was to review 3 cases of injury to the plantar plate of the first MTPJ in contact athletes and to focus on diagnosis and treatment of the more severe toe injuries. CASE REPORTS Case 1A 21-year-old running back participating in National Collegiate Athletic Association (NCAA) Division I football injured his left great toe during his first carry of the game. He was cutting on a FieldTurf (FieldTurf, Calhoun, GA) playing surface when he ...

Fracture of the fibular sesamoid bone of the metatarsophalangeal joint of the big toe

“…Turf toe injury typically describes an injury to the metatarsosesamoid complex of the hallux generally caused by a hyperextension force to the great toe. This injury may be accompanied by pain, deformity, and decreased athletic performance [6]. While acute traumatic fractures may occur with severe axial loading and abduction, stress fractures can occur with repeated weight-bearing as a result of inappropriate running accompanied by 1.metatarsophalangeal joint dislocation, such as may be seen in footballers [2,3].…”

“…Taking an additional axial sesamoid radiograph is extremely useful in identifying narrowing of the joint space and sclerosis associated with osteochondritis of the sesamoid. CT and bone scintigraphy examinations are thought to be helpful in confirming the diagnosis, but recent studies have shown low specificity of bone scintigraphy in sesamoid injuries and have reported that CT imaging is more helpful in the diagnosis of these injuries [5][6][7][8]. There may be non-fusion of one or more ossification centers during the formation of the sesamoid bone, and this increases the possibility of 'partite'.…”

Open dislocation of the interphalangeal joint associated with running barefoot

“…One well-recognised repeated strain injury of the hallux is ‘turf toe’, which results in pain and impaired function due to hyperextension of the metatarsophalangeal joint 1. This patient, however, sustained a more severe injury, and appears to have generated enough shearing stress to disrupt the joint capsule and overlying skin, resulting in an open dislocation.…”

Turf toe

“…They are the short flexor complex (the flexor hallucis brevis (FHB) and the sesamoids embedded in the FHB tendons), the adductor hallucis and the abductor hallucis tendons. 12 The FHB tendon inserts on the proximal phalanx in confluence with the plantar plate. As the FHB moves distally toward its insertion, the tendon envelops the medial (tibial) and lateral (fibular) sesamoids.…”

“…The athlete should use a stiff-soled shoe with a turf toe plate insert or a custom orthotic with a Morton’s extension to limit hallux motion. 12 If the injury is more medially based and there is concern of a traumatic hallux valgus, a toe separator between the hallux and second toes can provide further support.…”