Acute fractures of medial and lateral great toe sesamoids in an athlete

Simultaneous medial and lateral hallucal sesamoid fractures in a basketball player mimicking bipartite sesamoid condition

Simultaneous fractures of the medial and lateral hallucal sesamoids from sports injuries are an extremely uncommon occurrences, with only one case reported in a hurdler. We describe an unusual injury in a basketball player resulting in simultaneous fractures of the medial and lateral hallucal sesamoid bones, a presentation, which we believe has not been reported before in the literature. With a growing interest in sports, the frequency of such injuries will undoubtedly rise. We highlight the clinical characteristics, biomechanical mechanism, role of complementary cross-sectional imaging in the diagnosis of hallucal sesamoid fractures. This case report emphasizes the need of high index of suspicion in reaching conclusive diagnosis of such rare injuries to prevent long term complications such as avascular necrosis or non-union and facilitate early return to sporting activities.

Turf Toe Review

Turf toe is a term used to describe myriad injuries to the metatarsophalangeal complex of the great toe, which have been associated with the introduction of artificial turf surfaces in sport. If not diagnosed early and treated properly, these injuries can result in chronic pain and loss of mobility. Accurate injury grading through physical exam and advanced imaging is essential to guide treatment, thereby minimizing long-term complications and maximizing an athlete's recovery and return to play. Levels of Evidence: Level V.

Ankle Injuries in Dancers

The term dance encompasses a broad range of different styles; much of the orthopaedic literature has focused on ballet dancers. Injury is common in dancers at all levels, and many serious dancers sustain multiple injuries as they progress through their career. Foot and ankle injuries are among the most common injuries experienced by dancers. These injuries include those that are specific to dancers because of the unique physical maneuvers required to effectively perform, but they can also include common injuries that may require relatively different treatment because of the physical demands of the dancer. Os trigonum syndrome and flexor hallucis longus tenosynovitis generally fall into the former category as they are injuries that are more prevalent in dancers due to the extreme plantarflexion involved in dancing, especially ballet, and the relative demand placed on the toe flexors, most notably the flexor hallucis longus. On the other hand, anterior ankle impingement occurs both in dancers and in the general public. In many cases, a team approach to treatment with knowledgeable physical therapists can obviate the need for surgical treatment. If surgical treatment proves necessary, good results can be achieved with sound surgical technique and a well thought-out rehabilitation program.

Chronic lateral ankle instability increases the likelihood for surgery in athletes with os trigonum syndrome

PURPOSE

The etiology and incidence of os trigonum syndrome in professional athletes is highly variable. There is a paucity of data to ascertain why some athletes evolve towards surgery whilst others remain asymptomatic. We hypothesized that a lateral ligament ankle injury would increase the likelihood for surgery in those athletes with os trigonum syndrome.

METHODS

Eighty professional athletes with clinical and radiological signs of os trigonum syndrome were identified to ascertain the incidence of injury to the lateral ligamentous ankle complex (acute and chronic) by magnetic resonance imaging (MRI). This cohort was subdivided into 2 groups; a surgical (n = 40) and a non-surgical (n = 40) cohort. Surgical division was decided if (1) the clinical hyper-plantar flexion test was positive, (2) a positive diagnostic ultrasound-guided injection and (3) no improvement was observed after 6 weeks of conservative rehabilitation.

RESULTS

From the surgical cohort, 37 players (94.1%) had a chronic lateral ankle ligament injury on MRI, whilst 3 players (5.9%) had an acute lateral ankle ligament injury. Binary logistic linear modelling revealed that having a chronic lateral ligament injury increases the likelihood of os trigonum syndrome surgery by ten times compared to those with an acute lateral ligament injury.

CONCLUSION

Professional athletes with chronic lateral ligament ankle injury have an approximate ten times greater risk for os trigonum syndrome surgery compared to athletes with acute lateral ligament ankle injury.

LEVEL OF EVIDENCE

IV.

Turf toe: A clinical update

Turf toe is a condition that describes injury to the plantar metatarsophalangeal-sesamoid complex of the great toe.

It is a relatively rare and debilitating condition, particularly seen in American footballers after the introduction of harder, artificial ‘turf’ surfaces.

Turf toe represents a significant injury to the hallux and requires a high index of suspicion.

If unrecognized, it can lead to chronic problems including reduced push-off strength, persistent pain, progressive deformity and eventual joint degeneration.

Patients with chronic injuries may have worse outcomes, and therefore early, accurate diagnosis and initiation of treatment play a vital role.

A multidisciplinary team approach is key for successful return to sport.

Cite this article: EFORT Open Rev 2018;3:501-506. DOI: 10.1302/2058-5241.3.180012

Management of sports injuries of the foot and ankle: An update

Injuries to the foot in athletes are often subtle and can lead to a substantial loss of function if not diagnosed and treated appropriately. For these injuries in general, even after a diagnosis is made, treatment options are controversial and become even more so in high level athletes where limiting the time away from training and competition is a significant consideration. In this review, we cover some of the common and important sporting injuries affecting the foot including updates on their management and outcomes. Cite this article: Bone Joint J 2016;98-B:1299-1311.

Plantar-plate disruptions: "the severe turf-toe injury." three cases in contact athletes

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.

Posterior ankle impingement syndrome caused by malunion of joint depressed type calcaneal fracture

Late complications after calcaneal fracture usually resulted in lateral heel pain. Malunion of joint depressed type calcaneal fracture can result in posterior ankle impingement pain. This is caused by the posterior calcaneal bone spike formed just behind the posterior calcaneal facet. We describe a technique to resect the offending posterior calcaneal bone spike to relieve the posterior ankle impingement pain.

Posterior arthroscopic excision of bilateral posterior bony impingement syndrome of the ankle: a case report

The common cause of posterior ankle impingement syndrome (PAIS) is impingement of the os trigonum or talar posterior process. There were few reports of bilateral PAIS of the os trigonum, and bilateral PAIS of the talar posterior process has not been previously reported. The authors report the case of a 32-year-old man who was diagnosed with bilateral PAIS related to a prominent lateral tubercle of the talar posterior process, and who was treated by posterior arthroscopic excision through posterolateral and posteromedial portals in a prone position. His preoperative posterior ankle pain disappeared completely after surgery, and the patient returned to contact sports 3 months postoperatively.

Endoscopic resection of a symptomatic os trigonum

The purpose of this study was to describe our technique and results of arthroscopic resection of a symptomatic os trigonum via two posterior portals in 10 cases. Between 1999 and 2005 we treated 10 patients with endoscopic resection of a symptomatic os trigonum. The age ranged between 19 and 32 years (average 25.9). The average follow-up was 25 months (6-61 months). Time interval between the onset of pain and endoscopic resection of the os trigonum was 20 months. Of the 10 patients, 9 were symptom free for activities of daily living (ADL) within 4 weeks after surgery. They resumed their professional sport activities in a period of 8 weeks. The average AOFAS ankle/hindfoot scale increased from 43 preoperative to 87 postoperatively. We observed no complication in these 10 patients. Endoscopic resection of the symptomatic os trigonum yields good results with minimal surgical morbidity and short recovery time.

Subacute posteromedial impingement of the ankle in athletes: MR imaging evaluation and ultrasound guided therapy

OBJECTIVE

To describe the use of MR imaging and efficacy of ultrasound-guided steroid injection in the diagnosis and management of athletes with clinical posteromedial impingement of the ankle.

DESIGN AND PATIENTS

A retrospective analysis of imaging findings on MR was undertaken in nine elite athletes with clinical posteromedial ankle impingement. MR studies from six professional athletes with posterolateral pain were also reviewed as an imaging control group. The two reviewing radiologists were blinded to the clinical details and the proportion of control and study subjects. The nine study athletes also underwent diagnostic ultrasound and ultrasound-guided injection of steroid and anaesthetic into the posteromedial capsular abnormality. Follow-up was by telephone interview.

RESULTS

Posteromedial capsular thickening was seen only in athletes with posteromedial impingement (7/9). Posteromedial synovitis was present in all athletes with posteromedial impingement; however, posterior and posterolateral synovitis was also seen in these athletes. Mild posteromedial synovitis was present in two control athletes. Ultrasound identified abnormal posteromedial soft tissue thickening deep to tibialis posterior between the medial malleolus and talus in all nine athletes. After injection all athletes returned to their previous level of sport, with eight of the nine not experiencing any residual or recurrent symptoms.

CONCLUSION

If MR imaging excludes significant coexistent abnormality, ultrasound can localise posteromedial soft tissue abnormality and guide injection therapy, allowing return to athletic activity without surgical intervention.