The purpose of this study was to review three cases of injury to the plantar plate of the first metatarsophalangeal joint (MTPJ) in contact athletes and to focus on diagnosis and treatment of the more severe toe injuries.
The first case involved a 21-year-old running back participating in National Collegiate Athletic Association (NCAA) Division I football with an injured hallux, which was painful and swollen.
On physical examination, he had a slight flexion contracture of the first MTPJ, which was passively correctable; instability with drawer testing; plantar ecchymosis; and complete loss of plantar-flexion strength when the flexor hallucis brevis (FHB) was isolated.
Radiographs showed proximal retraction of the sesamoids; magnetic resonance imaging confirmed the diagnosis as a complete plantar-plate injury.
Case 2 involved a 21-year-old NCAA offensive lineman who had difficulty with ambulation and was unable to continue playing. On physical examination, his foot was well aligned.
Radiographs with the toe in dorsiflexion demonstrated that his sesamoids did not migrate distally as they did on the contralateral side.
A medial incision revealed a complete disruption of the plantar plate and proximal retraction of the sesamoids.
Case 3 saw a 19-year-old NCAA linebacker with an injured left hallux.
On physical examination, he pointed to the medial and plantar portions of the first MTPJ as the major sites of pain. His alignment was normal.
The patient had some MTPJ flexor weakness, particularly when the FHB was isolated.
Radiographs showed a slight retraction of the sesamoids compared with the contralateral side.
Patients with turf toe can demonstrate a wide array of pathologic conditions. Close attention needs to be paid to the history and mechanism of injury.
Diagnostically, special consideration needs to be paid to the strength, range of motion, and stability examinations, as well as the ability to return to play.
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