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Claikens T, Rezaie W, Simons P. Turf Toe Injury: A Pictorial Review and a Didactic Case Report. Semin Musculoskelet Radiol 2024; 28:213-217. [PMID: 38484773 DOI: 10.1055/s-0043-1775863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Hyperextension of the first metatarsophalangeal joint can lead to a turf toe injury of the plantar plate complex, resulting in significant morbidity for athletes. This article reviews the anatomy, pathophysiology, classification, and imaging findings of turf toe injuries. In turf toe trauma, many different structures can be injured, with the sesamoid-phalangeal ligaments the most common. Diagnosis, classification, and treatment options rely on clinical evaluation and specific magnetic resonance imaging findings. It is vital for radiologists to understand the anatomy, pathophysiology, and imaging findings of turf toe injuries to ensure an accurate diagnosis and appropriate management.
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Affiliation(s)
- Tom Claikens
- Department of Radiology, OLV Ziekenhuis Aalst, Aalst, Belgium
| | - Wahid Rezaie
- Department of Orthopaedics, OLV Ziekenhuis Aalst, Aalst, Belgium
| | - Philip Simons
- Department of Radiology, OLV Ziekenhuis Aalst, Aalst, Belgium
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2
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Gupta A, Singh PK, Xu AL, Bronheim RS, McDaniel CM, Aiyer AA. Turf Toe Injuries in the Athlete: an Updated Review of Treatment Options, Rehabilitation Protocols, and Return-to-Play Outcomes. Curr Rev Musculoskelet Med 2023; 16:563-574. [PMID: 37789169 PMCID: PMC10587038 DOI: 10.1007/s12178-023-09870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW First metatarsophalangeal joint sprains or turf toe (TT) injuries occur secondary to forceful hyperextension of the great toe. TT injuries are common among athletes, especially those participating in football, soccer, basketball, dancing, and wrestling. This review summarizes the current treatment modalities, rehabilitation protocols, and return-to-play criteria, as well as performance outcomes of patients who have sustained TT injuries. RECENT FINDINGS Less than 2% of TT injuries require surgery, but those that do are typically grade III injuries with damage to the MTP joint, evidence of bony injury, or severe instability. Rehabilitation protocols following non-operative management consist of 3 phases lasting up to 10 weeks, whereas protocols following operative management consist of 4 phases lasting up 20 weeks. Athletes with low-grade injuries typically achieve their prior level of performance. However, among athletes with higher grade injuries, treated both non-operatively and operatively, about 70% are expected to maintain their level of performance. The treatment protocol, return-to-play criteria, and overall performance outcomes for TT injuries depend on the severity and classification of the initial sprain. For grade I injuries, players may return to play once they experience minimal to no pain with normal weightbearing, traditionally after 3-5 days. For grade II injuries, or partial tears, players typically lose 2-4 weeks of play and may need additional support with taping when returning to play. For grade III injuries, or complete disruption of the plantar plate, athletes lose 4-6 weeks or more depending upon treatment strategy.
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Affiliation(s)
- Arjun Gupta
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Priya K. Singh
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
- Department of Orthopaedic Surgery, Montefiore Medical Center at Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY 10461 USA
| | - Amy L. Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Rachel S. Bronheim
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Claire M. McDaniel
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
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3
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Edwards CR, Ahmad ZY, Vosseller JT, Moy MP, Wong TT. First MTP joint injuries: MR imaging findings in surgically managed patients. Skeletal Radiol 2023; 52:1729-1738. [PMID: 37043019 DOI: 10.1007/s00256-023-04327-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVES Determine whether MR imaging findings or demographics predict surgical management in patients with first MTP joint injuries. MATERIALS AND METHODS Retrospective study of 161 forefoot MRs for traumatic first MTP injury (M:F 92:69, mean age 33 ± 13 yrs.). Two radiologists reviewed imaging for ligamentous, osseous, and tendinous injuries. Ligaments and tendons were graded as 0:normal, 1:sprain or strain, 2:partial tear, 3:complete tear. Osseous injuries were classified as edema, fracture, or cartilage injury. Clinical data obtained included sex, age, injury acuity, sport participation, level of sport, and treatment. Imaging findings and demographic data were assessed to determine predictive factors for surgical management. Statistics included kappa, chi-squared, Fisher's exact, and logistic regression. RESULTS Logistic regression (odds ratio [95% CI], p-value) showed that grade 2 or 3 injuries of the plantar ligamentous complex (2.87, [1.10, 7.48], p = 0.031), grade 2 or 3 injuries of the medial collateral ligament (3.24, [1.16, 9.08], p = 0.025), and participation in collegiate or professional sports (4.34 [1.64, 11.52], p = 0.003) were associated with an increased rate of surgical intervention. k = ligamentous injury (0.71-0.83), osseous trauma (0.88-0.95), and tendon injury (0.78). All other imaging findings and demographic factors were not significant predictors of surgery (p > 0.05). CONCLUSION Participation in collegiate or professional sports and tears of the plantar ligamentous complex or medial collateral ligament predicted surgical management in patients with first MTP trauma.
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Affiliation(s)
- C R Edwards
- New York Presbyterian- Columbia University, New York, NY, USA.
| | - Z Y Ahmad
- New York Presbyterian- Columbia University, New York, NY, USA
| | - J T Vosseller
- Jacksonville Orthopaedic Institute, Jacksonville, FL, USA
| | - M P Moy
- New York Presbyterian- Columbia University, New York, NY, USA
| | - T T Wong
- New York Presbyterian- Columbia University, New York, NY, USA
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4
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Cho D, Kukadia S, Drakos M. Common Football Foot and Ankle Injuries: Non-Surgical and Surgical Management. HSS J 2023; 19:322-329. [PMID: 37435125 PMCID: PMC10331273 DOI: 10.1177/15563316231160458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/13/2022] [Indexed: 07/13/2023]
Affiliation(s)
- David Cho
- Hospital for Special Surgery, New York, NY, USA
| | | | - Mark Drakos
- Hospital for Special Surgery, New York, NY, USA
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Reeve A, Linklater JM, Dimmick DS. Lesser Metatarsophalangeal Joint Plantar Plate Degeneration and Tear and Acute First Metatarsophalangeal Joint Capsuloligamentous Injury: What the Surgeon Wants to Know. Semin Ultrasound CT MR 2023. [DOI: 10.1053/j.sult.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Madi NS, Parekh TJ, Parekh SG. Outcome of Turf Toe Injuries in NFL Players. J Foot Ankle Surg 2022; 62:115-119. [PMID: 35697653 DOI: 10.1053/j.jfas.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/22/2022] [Accepted: 05/14/2022] [Indexed: 02/03/2023]
Abstract
The increase in artificial turf in the 1970s was thought to have contributed to increased incidence of turf toe injury in National Football League (NFL) players. To our knowledge, there are no publications that have analyzed the impact of this injury on performance. This is a retrospective case series. Online resources were used to identify NFL players who sustained a turf toe injury between the 2011 and 2014 seasons. The performance of each offensive skill player was analyzed separately by calculating their power rating (PR) over 6 seasons. Injured offensive skill players were then compared to a control group consisting of all RBs and WRs without a turf toe injury who competed in the 2012 season. Seventy-one turf toe injuries were identified. Twenty-nine occurred on grass, 29 on turf and the playing surface of 13 injuries could not be identified. The average PR prior to injury was 105.7/season (7.3/game), 87.3 (6.9/game) for the season of injury and 115.5 (8.1/ game) for postinjury seasons. The PR was not significantly different after a turf toe injury compared to before injury or to uninjured control player. There was no significant difference in NFL players' performances after turf toe injury based on power ratings.
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Affiliation(s)
- Naji S Madi
- Foot & Ankle Surgery, Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC.
| | | | - Selene G Parekh
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC
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Husebye EE, Stødle AH. Arthroscopic Repair of Chronic Plantar Plate Tears of the First Metatarsophalangeal Joint: A New Surgical Technique With Patient Outcomes. Orthop J Sports Med 2022; 10:23259671221137558. [PMID: 36582934 PMCID: PMC9793050 DOI: 10.1177/23259671221137558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Most plantar plate tears of the first metatarsophalangeal joint can be treated successfully by nonoperative means. Primary repair may be indicated to restore continuity of the plantar structures and joint stability. Inadequate or failed nonoperative treatment may cause persistent pain and disability and thereby represent a career-threatening injury to an athlete. The chronic plantar plate tears are difficult both to diagnose and to treat. When surgical treatment is indicated, traditionally a wide plantar or 2 parallel incisions are used. An arthroscopic approach allows for verification and visualization of the injury and, at the same time, repair of the injury. Purpose To describe findings of plantar plate tears, present a new arthroscopic procedure for plantar plate tear repair, and present the outcomes after surgery. Study Design Case series; Level of evidence, 4. Methods This was a retrospective study on the first 10 patients treated with the arthroscopic technique. The patients underwent surgery between June 2017 and January 2021. Patient data, clinical symptoms and findings, and operative details were obtained from the patient records. Patients were contacted via email to complete patient-reported outcome measures (Manchester Oxford Foot Questionnaire [MOxFQ] and Numeric Rating Scale [NRS] for pain). Results Four female and 6 male patients with a median age of 24 years (range, 12-44 years) were operated on at a median of 20 months (range, 2-38 months) after injury. Of the 10 patients, 8 had a hyperextension injury of the first metatarsophalangeal joint and 7 had a subtle valgus malalignment of the hallux; 8 patients were injured during sport activity. All patients reported plantar pain at pushoff. All but 1 patient returned to the same level of preinjury activity within 6 months. At a median of 29 months (range, 7-49 months) after surgery, the median MOxFQ score was 6 (range, 0-41) and the median NRS pain score was 0. Conclusion Arthroscopic plantar plate repair of chronic plantar plate tears resulted in a high rate of return to activity/sport and excellent outcome scores.
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Affiliation(s)
- Elisabeth Ellingsen Husebye
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo,
Norway.,Elisabeth Ellingsen Husebye, MD, PhD, Division of Orthopaedic
Surgery, Oslo University Hospital, Oslo, Norway (email
, )
(Twitter: @ElisabethEllin9)
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Dimmick S, Reeve A, Linklater J. Presurgical Perspective and Postsurgical Evaluation of Plantar Plate and Turf Toe. Semin Musculoskelet Radiol 2022; 26:695-709. [PMID: 36791738 DOI: 10.1055/s-0042-1760221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Capsuloligamentous injury of the first metatarsophalangeal (MTP) joint (eponymously called "turf toe") mostly occurs in athletes and involves acute trauma, whereas tears of the lesser MTP joint plantar plate typically are an attritional-degenerative condition. This article reviews the anatomy, pathophysiology, mechanism and patterns of injury, grading and classification of injury, imaging appearances (pre- and postoperative), and management of first MTP joint capsuloligamentous injuries and lesser MTP joint plantar plate tears. These two distinct pathologies are discussed in separate sections.
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9
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The Utility of Ultrasound in the Evaluation of Traumatic Hallux Valgus. Am J Phys Med Rehabil 2022; 101:e145-e148. [PMID: 35836317 DOI: 10.1097/phm.0000000000002073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Isolated disruption of the medial collateral ligament of the great toe is rare and often misdiagnosed as turf toe. It may progress to acquired traumatic hallux valgus, often requiring operative intervention and a longer return to play. This case of a grade II medial collateral ligament injury highlights the importance of a thorough physical examination and consideration of the mechanism of injury. It demonstrates the utility of diagnostic musculoskeletal ultrasound in establishing a specific diagnosis upon initial patient presentation with great toe pain. It is an example of the use of ultrasound in guiding treatment and monitoring interval healing. In this case, differentiation of the injury from the classic "turf toe" led to proper stabilization with a toe spacer and activity modification, thus preventing progression of traumatic hallux valgus and leading to successful nonoperative treatment with full return to sport. LEVEL OF EVIDENCE Level V.
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Scala VA, Kikuchi CK. Sesamoid Avascular Necrosis and Stress Fracture Treated with Core Decompression and Biologic Augmentation. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:16-18. [PMID: 35340940 PMCID: PMC8941614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sesamoid bone disorders are disabling conditions with limited treatment options. This case report describes a 17-year-old football player with avascular necrosis (AVN) in both the tibial and fibular hallux sesamoids with a concomitant non-displaced stress fracture of the tibial hallux sesamoid. After a short period of conservative management, the patient underwent open sesamoid core decompression with an application of concentrated bone marrow aspirate and amnion matrix. After postoperative physical therapy, the patient achieved a painless range of motion of the first metatarsophalangeal joint. He returned to full athletic activities by 6 months postoperatively. Core decompression with biologic augmentation is a viable treatment option for sesamoid AVN. Earlier surgical intervention for sesamoid AVN can also be considered, particularly in younger active patients.
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Affiliation(s)
- Victoria A. Scala
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Christian K. Kikuchi
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Strassberg J, Ahmed A. Pediatric Sports Injuries. Clin Podiatr Med Surg 2022; 39:89-103. [PMID: 34809797 DOI: 10.1016/j.cpm.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recreational sports are more popular, with many athletes involved year-round in multiple sports and on multiple teams. Most athletes do not take proper rest, making them more susceptible to stress-related injuries. There are numerous sports-related injuries in the foot and ankle. These issues can be non-traumatic, due to chronic repetitive stresses, or traumatic. Most of these injuries are managed conservatively, and athletes do well and return to play, while some do better with operative management. This article discusses a few of the sports injuries that are common in the leg, foot, and ankle and the recovery process.
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Affiliation(s)
- Joshua Strassberg
- The Pediatric Orthopedic Center, 218 Ridgedale Avenue, Suite 101, Cedar Knolls, NJ 07927, USA
| | - Aamir Ahmed
- Ankle and Foot Doctors of New Jersey, 225 Millburn Avenue, Suite #104B, Millburn, NJ 07041, USA.
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12
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Schafer KA, McCormick JJ. Turf Toe and Sesamoiditis. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Wang JE, Bai RJ, Zhan HL, Li WT, Qian ZH, Wang NL, Yin Y. High-resolution 3T magnetic resonance imaging and histological analysis of capsuloligamentous complex of the first metatarsophalangeal joint. J Orthop Surg Res 2021; 16:638. [PMID: 34689814 PMCID: PMC8543817 DOI: 10.1186/s13018-021-02795-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are discrepancies in the understanding of the structure of the capsuloligamentous complex of the first metatarsophalangeal joint (MTPJ); this study aims to investigate the differences with previous anatomical reports of high-resolution 3T magnetic resonance imaging (MRI) and histological analysis in illustrating the structure of the capsuloligamentous complex of the first MTPJ. Methods Nine fresh frozen cadaveric feet specimens (from two women and three men; aged 32 to 58 years) were used in this study. All specimens underwent MR examination with T1-weighted imaging and T2-weighted spectral attenuated inversion recovery in three planes. Subsequently, all cadaveric feet specimens were sliced into 2-mm-thick sections. The MRI features of the capsuloligamentous complex of the first MTPJ were analyzed in these specimens. Hematoxylin–eosin and Masson’s trichrome staining methods were used to explore the histologic features of the capsuloligamentous complex of the first MTPJ. Results Different from most previous studies, our results showed that the plantar plate could be divided into four portions including the central portion of the plantar plate, the intersesamoid, the sesamoid phalangeal and the metatarsosesamoid ligaments. The normal central portion of the plantar plate could be clearly visualized in the sagittal and coronal plane MR images. The intersesamoid ligament is a continuation of the central portion of the plantar plate on the sagittal plane on the gross specimen, the MR imaging, and the histological examination. On the coronal plane of the gross specimen and MR imaging, the sesamoid phalangeal ligaments and the central portion of the plantar plate can be seen as separate ligaments, but they appeared interwoven with the same continuous collagenous fibers on the histological analysis. Conclusion High-resolution 3T MRI allows accurate demonstration of the different anatomical details of the capsuloligamentous complex of the first MTPJ from previous anatomical reports. The histological analysis provides further understanding of the structures of the capsuloligamentous complex of the first MTPJ from previous studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02795-7.
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Affiliation(s)
- Jin-E Wang
- Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China
| | - Rong-Jie Bai
- Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China. .,Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Hui-Li Zhan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Wen-Ting Li
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Zhan-Hua Qian
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Nai-Li Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Yuming Yin
- Direct Radiology, 3501 Ocean Drive, Corpus Christi, TX, 78411, USA
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14
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Abstract
Turf toe is a common injury of the hallux metatarsophalangeal (MTP) joint in athletes which is the result of hyperdorsiflexion injury. While the term turf toe has been used to describe a variety of first MTP joint injuries, the term is now typically used in imaging to describe tearing or injury to the plantar plate complex. This review article will cover normal anatomy of the first MTP joint, mechanism of injury, typical imaging findings in normal individuals on MRI and ultrasound, as well as the most common patterns of injury.
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Affiliation(s)
- Michael T Perry
- Department of Radiology and Medical Imaging, University of Virginia, PO Box 800170, Charlottesville, VA 22908, USA.
| | - Jennifer L Pierce
- Department of Radiology and Medical Imaging, University of Virginia, PO Box 800170, Charlottesville, VA 22908, USA
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Walley KC, Muscatelli SR, Singer N, Nicholas M, Holmes JR, Walton DM, Talusan PG. First Metatarsophalangeal Lateral Collateral Ligament Repair in an Athlete: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00055. [PMID: 34329201 DOI: 10.2106/jbjs.cc.20.00901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Evidence-based surgical strategies to reconstruct the collateral ligament complex of the first metatarsophalangeal (MTP) joint are not available. We report a case of first MTP lateral collateral ligament insufficiency in a young, female gymnast with varus laxity and subsequent satisfactory mid-term and long-term outcomes. CONCLUSION This case report describes an efficient suture anchor technique for restoring stability of the first MTP joint because of chronic varus laxity with acceptable results both clinically and with patient-reported outcome scores at mid-term and long-term follow-ups. We suggest that our strategy is a viable option for addressing chronic varus laxity of the first MTP joint. LEVEL OF EVIDENCE Level IV, case report.
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Affiliation(s)
- Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, Michigan
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Carneiro BC, Araújo FF, Guimarães JB, Chemin RN, Jorge RB, Filho AGO, Nico MAC. Stener-like lesions in the hand, knee and foot: a review of anatomy, mechanism of injury and imaging evaluation. Clin Imaging 2021; 76:235-246. [PMID: 33975225 DOI: 10.1016/j.clinimag.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
A Stener lesion is a displaced tear of the ulnar collateral ligament in the metacarpophalangeal joint of the thumb in which the adductor pollicis aponeurosis is positioned between the retracted ligament and the injury site, preventing natural healing. This lesion was first described in 1962, and since then, both radiologists and orthopedists have considered it important to treat surgically. Although this lesion was originally described in the thumb, this injury mechanism can occur in other joints of the hand, knee, and foot. The purpose of this study was to review the relevant aspects of classic Stener lesions of the thumb, as well as other Stener-like lesions, including their anatomy, mechanisms of lesion formation and imaging features. The Stener-like injury pattern often necessitates surgical repair or reconstruction; thus, it is essential that radiologists recognize and report the different patterns of injury.
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Affiliation(s)
- Bruno Cerretti Carneiro
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Flávia Ferreira Araújo
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Renan Nogueira Chemin
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Rafael Baches Jorge
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Alípio Gomes Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Marcelo Astolfi Caetano Nico
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
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Thevendran G, Kadakia AR, Giza E, Haverkamp D, D'Hooghe JP, Veljkovic A, Abdelatif NMN. Acute foot and ankle injuries and time return to sport. SICOT J 2021; 7:27. [PMID: 33861196 PMCID: PMC8051311 DOI: 10.1051/sicotj/2021024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/20/2021] [Indexed: 01/18/2023] Open
Abstract
Foot and ankle sports injuries encompass a wide spectrum of conditions from simple contusions or sprains that resolve within days to more severe injuries that change the trajectory of an athlete’s sporting career. If missed, severe injuries could lead to prolonged absence from the sport and therefore a catastrophic impact on future performance. In this article, we discuss the presentation of the commonest foot and ankle sports injuries and share recent evidence to support an accurate diagnosis and best management practice.
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Affiliation(s)
- Gowreeson Thevendran
- Consultant Orthopaedic Surgeon, Mount Elizabeth Novena Hospital, 38 Irrawaddy Road, 329563, Singapore
| | - Anish R Kadakia
- Professor of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, 60611 IL, USA
| | | | - Daniel Haverkamp
- Xpert Clinics Orthopedics, Laarderhoogtweg 12, 1101 EA Amsterdam, The Netherlands
| | - Jonkheer Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, 29222 Doha, Qatar
| | - Andrea Veljkovic
- Department of Orthopaedic Surgery, St. Paul's Hospital, Footbridge Clinic, University of British Columbia, Vancouver, V6T 1Z4 BC, Canada
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Abstract
In athletes, foot injuries present with a variety of mechanisms, severity, and implications for return to play. Although potentially given less attention than knee and shoulder injuries by the team physician, foot injuries are common and thus require knowledgeable consideration. In this article, we review the anatomy, presentation, workup, and management of several of the most common athletic foot injuries, including turf toe, Lisfranc injuries, Jones fractures, and navicular stress fractures. The goal is to provide the team physician with the information necessary to evaluate and manage these injuries on the sideline and in the training room.
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Affiliation(s)
- William A Davis
- DuPage Medical Group, Team Physician - North Central College, 100 Spalding Drive, Suite 300, Naperville, IL 60540, USA.
| | - Gautam P Yagnik
- Miami Orthopaedic and Sports Medicine Institute, Florida International University, Herbert Wertheim College of Medicine, Team Physician- NFL Miami Dolphins and NHL Florida Panthers, Baptist Health South Florida, 1150 Campo Sano Avenue, Coral Gables, FL 33146, USA
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19
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Abstract
Turf toe injuries have been increasing in numbers in recent years. Injury to the plantar restraints of the first metatarsophalangeal joint can lead to significant disability in athletes, affecting their push-off and ability to perform on the athletic field. Most turf toe injuries can be treated conservatively with rest, ice, compression, immobilization if needed, and a dedicated rehabilitation program; however, in some injuries, the plantar restraints are torn and the joint becomes unstable. If necessary, turf toe injury and its many variants can be surgically repaired with the expectation that the athlete will be able to return to play.
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Affiliation(s)
- Norman E Waldrop
- Andrews Sports Medicine and Orthopaedic Center, 805 St. Vincent's Drive, Suite 100, Birmingham, AL 35205, USA.
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20
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Kadakia AR, Alshouli MT, Barbosa MP, Briggs D, Mutawakkil M. Turf Toe, Traumatic Hallux Valgus, and Hallux Rigidus -What Can I Do After an Metatarsophalangeal Fusion? Clin Sports Med 2020; 39:801-818. [PMID: 32892968 DOI: 10.1016/j.csm.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Turf toe injuries should be recognized and treated early to prevent long-term disability. The accurate clinical assessment and radiological evaluation of appropriate cases is important. Both conservative and surgical treatments play a major role in getting athletes back to their preinjury level. There are more recent reported case series and systemic reviews that encourage operative treatment as early as possible for grade III turf toe injury. If the patient presents late from a traumatic hallux injury with subsequent degenerative changes or has hallux rigidus from other etiologies, a first metatarsophalangeal arthrodesis should be considered to minimize pain and improve function.
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Affiliation(s)
- Anish R Kadakia
- Department of Orthopedic Surgery, Center for Comprehensive Orthopaedic and Spine Care, Northwestern Memorial Hospital, Northwestern University, 259 East Erie, 13th Floor, Chicago, IL 60611, USA.
| | - Mohammed T Alshouli
- Prince Mohammed Bin AbdulAziz Hospital, Imam Bin Saud University, College of Medicine, Dar Aloloom University, College of Medicine, Riyadh, Saudi Arabia
| | - Mauricio P Barbosa
- Orthobone Clinic, Asccociaiacao Beneficente Siria HCor, Sao Paul, Brazil
| | - Daniel Briggs
- Department of Orthopedic Surgery, Center for Comprehensive Orthopaedic and Spine Care, Northwestern Memorial Hospital, 259 East Erie, 13th Floor, Chicago, IL 60611, USA
| | - Muhammad Mutawakkil
- Department of Orthopedic Surgery, Center for Comprehensive Orthopaedic and Spine Care, Northwestern Memorial Hospital, 259 East Erie, 13th Floor, Chicago, IL 60611, USA
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21
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Del Vecchio JJ, Dalmau-Pastor M. Percutaneous Lateral Release in Hallux Valgus: Anatomic Basis and Indications. Foot Ankle Clin 2020; 25:373-383. [PMID: 32736735 DOI: 10.1016/j.fcl.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the last decade, minimally invasive or percutaneous surgery has evolved rapidly through the development of novel techniques. Treatment of hallux valgus deformity is one of the indications for percutaneous surgery, both for bony and soft tissue correction. The release of the structures on the lateral part of the first metatarsophalangeal joint (lateral release) is one of the best indications for percutaneous surgery in the forefoot. In this article, a detailed description of the anatomy of the metatarsophalangeal joint is provided, along with the indications and tips to perform a safe percutaneous lateral release.
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Affiliation(s)
- Jorge Javier Del Vecchio
- GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France; Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro -Hospital Universitario, Solis 461, Ciudad Autónoma de Buenos Aires (CABA) CP 1078, Argentine; Department of Kinesiology and Physiatry, Universidad Favaloro, Av. Entre Ríos 495, CABA CP 1079, Argentina
| | - Miki Dalmau-Pastor
- GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France; Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona. C/ Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Office 5304, Barcelona, Spain.
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22
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Seow D, Tengku Yusof TNB, Yasui Y, Shimozono Y, Kennedy JG. Treatment Options for Turf Toe: A Systematic Review. J Foot Ankle Surg 2020; 59:112-116. [PMID: 31882133 DOI: 10.1053/j.jfas.2018.12.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/03/2018] [Accepted: 12/16/2018] [Indexed: 02/03/2023]
Abstract
Turf toe is hyperextension injury of the plantar plate at the first metatarsophalangeal joint. Etiologies have often included sports/activities with excessive forefoot axial loading and/or violent pivotal movements. The purpose of the systematic review was to systematically review and present an overview for the current evidence-based treatment options of turf toe. Both authors systematically reviewed the PubMed and EMBASE databases from inception to April 2016 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The level of evidence and quality of evidence were assessed by using the Level of Evidence for Primary Research Question of the Journal of Bone and Joint Surgery, and the quality of evidence was assessed with use of the Newcastle-Ottawa scale. Data were collected and categorized into: case reports and case series. Eight studies (16 turf toes) met the aforementioned criteria and were included. Five case reports and 3 case series reported various treatment options for turf toe. Specifically, 3 studies reported solely conservative treatment (n = 5), 1 study reported solely surgical treatment (n = 1), and 4 studies involved patients in conservative and/or surgical treatments (n = 10). All studies were of level of clinical evidence 4 and quality of clinical evidence score 2 (poor quality). Conservative treatment included closed reduction and immobilization, and surgical treatment included plantar plate tenodesis. Restricted dorsiflexion was the most common complication reported. Turf toe is an underreported injury with no evidence-based treatment guideline to date. Future studies of higher level and quality of evidence with a specific classification system (Jahss or Anderson) consistently reported are warranted for the development of an optimal guideline to determine the most appropriate treatment for each specific severity in injury.
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Affiliation(s)
- Dexter Seow
- Research Fellow, Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
| | | | - Youichi Yasui
- Assistant Professor, Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshiharu Shimozono
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Orthopedic Surgeon, Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - John G Kennedy
- Chief of Foot and Ankle Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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23
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Mehtar M, Saragas NP, Ferrao PN. Functional and patient reported outcomes following lateral hallucal sesamoidectomy. Foot (Edinb) 2020; 43:101656. [PMID: 32078908 DOI: 10.1016/j.foot.2019.101656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/10/2019] [Accepted: 11/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lateral hallucal sesamoidectomy is an infrequently performed procedure indicated for patients with sesamoid pathology failing conservative treatment. Concerns exists regarding patient satisfaction, plantar scar pain, hallux malalignment and metatarsophalangeal joint (MTPJ) movement restriction following sesamoidectomy. This study aims to assess patient satisfaction after lateral hallucal sesamoidectomy via the plantar approach. METHODS In this retropective study with prospective follow-up, all patients who underwent lateral hallucal sesamoidectomy between January 2004 and December 2017 were reviewed. Twelve patients (14ft.) were available for final assessment. Outcome measures were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale and the Self-Reported Foot and Ankle questionnaire (SEFAS). Patients were assessed clinically and radiologically. The average postoperative follow-up was 111.5 months (range 28-177 months). RESULTS All patients reported excellent outcome scores with a mean SEFAS score of 46.08 (range 43-48) and a mean AOFAS score of 92.33 (range 78-100) at final follow-up. All twelve patients reported their outcome as being excellent. No malalignment was noted clinically, however, three patients had a noticeable increase in the gap between the hallux and second toe when compared to the contralateral side. Range of motion at the MTPJ was preserved with a mean dorsiflexion of 80.83° (range 70-90°) and a mean plantarflexion was 25.83° (range 0-30°). None of the patients experienced any pain, discomfort or irritation related to the plantar scar. One patient developed neuroma like symptoms in the first web space. CONCLUSION Lateral hallucal sesamoidectomy via a plantar approach is an effective and reliable treatment option as demonstrated by the high levels of patient satisfaction, preservation of function, excellent PROM scores and limited complications in this study. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- M Mehtar
- Netcare Linksfield Orthopaedic Sports & Rehabilitation Centre (Clinic), Johannesburg, South Africa; Orthopaedic Department, University of the Witwatersrand, Johannesburg, South Africa.
| | - N P Saragas
- Netcare Linksfield Orthopaedic Sports & Rehabilitation Centre (Clinic), Johannesburg, South Africa; Orthopaedic Department, University of the Witwatersrand, Johannesburg, South Africa
| | - P N Ferrao
- Netcare Linksfield Orthopaedic Sports & Rehabilitation Centre (Clinic), Johannesburg, South Africa; Orthopaedic Department, University of the Witwatersrand, Johannesburg, South Africa
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24
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Hallinan JTPD, Statum SM, Huang BK, Bezerra HG, Garcia DAL, Bydder GM, Chung CB. High-Resolution MRI of the First Metatarsophalangeal Joint: Gross Anatomy and Injury Characterization. Radiographics 2020; 40:1107-1124. [PMID: 32412828 DOI: 10.1148/rg.2020190145] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The first metatarsophalangeal joint (MTPJ) is vital to the biomechanics of the foot and supports a weight up to eight times heavier than the body during athletic activities. The first MTPJ comprises osseous and cartilaginous surfaces along with a complex of supporting structures, including the dorsal extensor tendons, collateral ligaments, and a plantar plate complex. In contradistinction to the lesser MTPJ plantar plates, a single dominant fibrocartilaginous capsular thickening does not exist at the first MTPJ. Instead, the plantar plate complex comprises a fibrocartilaginous pad that invests the hallux sesamoids and is inseparable from the plantar capsule, the intersesamoid ligament, paired metatarsosesamoid and sesamoid phalangeal ligaments (SPLs), and the musculotendinous structures. Acute injury at the first MTPJ is typically secondary to forced hyperextension-turf toe-and can involve multiple structures. During hyperextension, the resulting forces primarily load the distal SPLs, making these structures more susceptible to injury. SPL injuries are best seen in the sagittal plane at MRI. Radiography can also aid in diagnosis of full-thickness SPL tears, demonstrating reduced sesamoid excursion at lateral dorsiflexed (stress) views. Hallux valgus is another common condition, resulting in progressive disabling deformity at the first MTPJ. Without appropriate treatment, first MTPJ injuries may progress to degenerative hallux rigidus. The authors detail the anatomy of the first MTPJ in cadaveric forefeet by using high-resolution 3-T and 11.7-T MRI and anatomic-pathologic correlation. Injuries to the plantar plate complex, collateral ligaments, and extensor mechanism are discussed using clinical case examples. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- James T P D Hallinan
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Sheronda M Statum
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Brady K Huang
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Higor Grando Bezerra
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Diego A L Garcia
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Graeme M Bydder
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Christine B Chung
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
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25
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Abstract
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.
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Affiliation(s)
- Daniel Chiou
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (DC).,Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts (KLS, GW)
| | - Kristen L Stupay
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (DC).,Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts (KLS, GW)
| | - Gregory Waryasz
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (DC).,Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts (KLS, GW)
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26
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Outcomes of Chronic Turf Toe Repair in Non-athlete Population: A Retrospective Study. Indian J Orthop 2020; 54:43-48. [PMID: 32211128 PMCID: PMC7065733 DOI: 10.1007/s43465-019-00010-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/06/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Turf toe injuries, though most common in athletes, can also occur in non-athletes. No study exists in the current literature investigating operative outcomes in non-athlete patients with chronic turf toe injury. In this study, we present our outcomes on operatively treated turf toe injuries in non-athletes in the only cohort yet studied. METHODS Using ICD-10 codes, we assembled a cohort of 12 patients who underwent operative repair of chronic turf toe injury from January 2012 through January 2018 at the investigating institution. These 12 patients were evaluated to determine demographic information, method of injury, length of time from injury to surgery, clinical and radiologic characteristics of the injury, and operative outcomes including mean preoperative and postoperative VAS (Visual Analog Scale) scores, preoperative and postoperative FFI (Foot Function Index) scores, and postoperative complications. RESULTS On initial clinical presentation, all 12 patients had local tenderness with associated painful range of motion. Four patients had restricted range of motion, all patients had a positive Lachman test, two had local edema, and eight had hallux valgus deformity. Mean VAS improved from 4.6 (range 2-9) to 1 (range 0-4). Mean FFI improved from 102.5 (range 56-177) to 61.75 (range 23-144). All patients had a negative Lachman test at final follow-up. No patients developed major complications or required revision surgery. CONCLUSIONS Our study is the first to investigate operative outcomes following chronic turf toe injury in non-athlete patients. Based on our study, surgeons and patients can expect significant improvement in overall pain and function following surgery.
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27
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Nery C, Fonseca LF, Gonçalves JP, Mansur N, Lemos A, Maringolo L, Fonseca LF. First MTP joint instability - Expanding the concept of "Turf-toe" injuries. Foot Ankle Surg 2020; 26:47-53. [PMID: 30509556 DOI: 10.1016/j.fas.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/04/2018] [Accepted: 11/09/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the classic definition of the Turf-toe injury refers to a very specific clinical and pathological picture, we think that the concept can be broadened to encompass a wide variety of traumatic lesions of the first metatarsophalangeal joint (MTP1). These are lesions typically difficult to diagnose, with a large variation of outcomes and a potential to impair patients' functional performance on a definitive and perennial basis. The objective of this study is to present the result obtained by treating 24 cases of traumatic injuries to the MTP1 joint in a midterm follow-up time. METHODS In the period from 1999 to 2016, 24 patients were treated with MTP1 joint instability - "Expanded Turf-toe" - diagnosis. All patients were performing sports activities when they were injured: soccer (33%); martial arts (17%); running (13%); tennis (8%); olympic gymnastics (8%) and others (basketball, slalom, motorcycling, surfing, and ballet) (21%). Injuries were classified as Grade I (2 patients - 8%), Grade II (8 patients - 33%) and Grade III (14 patients - 59%) lesions. All patients with grades I and II were treated conservatively whereas those classified as grade III were treated surgically. RESULTS After an average follow-up of 4.5 years we observed an improvement in the AOFAS hallux score from 42 to 82 points after treatment (p<0.001). The most frequent cause was axial load with various direction of stress at the first MTP. The mechanism of lesion varied among extension with hallux varism (42%), pure hyperextension (25%), extension with hallux valgism (21%), pure hyperflexion (8%) and hyperflexion with hallux valgism (4%). A separate analysis of each group showed a significant improvement in AOFAS Hallux scores after treatment: 51-84 (p<0.001) and 36-81 (p<0.001) for conservative and surgical groups, respectively. Four patients with GIII injuries (29%) and two with GII injuries (20%) did not resume their previous activities. Although pre-treatment AOFAS hallux scores were significantly different between groups, post-treatment scores were similar (p=0.615). CONCLUSIONS Turf-toe is a serious injury that may prevent a high percentage of patients from resuming their previous physical activities. Mechanism of lesion might be varied generating a wide range of lesions that fit into the expanded concept of the Turf-toe injury. Both forms of treatment lead to satisfactory results if well conducted. The correct identification, classification, and grading of first metatarsophalangeal joint (MTP) instability helps in decision making and selection of the adequate treatment. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Caio Nery
- Orthopedics and Traumatology Department of UNIFESP - Paulista Medical School, Brazil.
| | - Lucas F Fonseca
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - João Paulo Gonçalves
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - Nacime Mansur
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - André Lemos
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - Leonardo Maringolo
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - Lucas F Fonseca
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
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28
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Thomas RL, Kuiper JH, Knight TP. Properties and Function of the Flexor Hallucis Capsularis Interphalangeus Tendon. Clin Anat 2019; 33:689-695. [PMID: 31581316 DOI: 10.1002/ca.23490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The fibrocartilagenous plantar plates of the forefoot are biomechanically important, forming the primary distal attachment for the plantar aponeurosis. They are integral to the function of the windlass mechanism in supporting the arches of the foot in gait. Dissection of the cadaveric hallux revealed an organised sagittal thickening of the dorsal side of the flexor hallucis longus (FHL) sheath, which attached the interphalangeal plantar plate to the metatarsophalangeal (MTP) plantar plate. A description of a similar structure was made in 1984 when it was termed the flexor hallucis capsularis interphalangeus (FHCI) - however, it has not been researched since, and we aim to study it further and identify its characteristics. METHOD Eight specimens were dissected from four cadavers. Two were stained and examined under magnification in both polarized and non polarized light. The remaining 6 were subjected to micrometer testing of their tensile properties. RESULTS Both the histological features and mechanical properties were consistent with tendon; with cross sectional area, ultimate tensile strength and stiffness varying between specimens. CONCLUSIONS Based on its location and properties, the FHCI tendon may be involved in limiting dorsiflexion of the first MTP joint and could have clinical relevance in pathological processes around both the first and second MTP joints. Clin. Anat., 33:689-695, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- R L Thomas
- Plastic Surgery Department, Derriford Hospital, Plymouth, United Kingdom
| | - Jan H Kuiper
- Institute for Science and Technology in Medicine, Keele University, Staffordshire, United Kingdom
| | - Timothy P Knight
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, United Kingdom
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29
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Poppe T, Reinhardt D, Tarakemeh A, Vopat BG, Mulcahey MK. Turf Toe: Presentation, Diagnosis, and Management. JBJS Rev 2019; 7:e7. [PMID: 31436580 DOI: 10.2106/jbjs.rvw.18.00188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tanner Poppe
- Department of Orthopedics, University of Kansas School of Medicine, Kansas City, Kansas
| | - Daniel Reinhardt
- Department of Orthopedics, University of Kansas School of Medicine, Kansas City, Kansas
| | - Armin Tarakemeh
- Department of Orthopedics, University of Kansas School of Medicine, Kansas City, Kansas
| | - Bryan G Vopat
- Department of Orthopedics, University of Kansas School of Medicine, Kansas City, Kansas
| | - Mary K Mulcahey
- Department of Orthopedics, Tulane University School of Medicine, New Orleans, Louisiana
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30
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Abstract
Avascular necrosis (AVN) of the sesamoid is pathology of the medial or lateral hallucal sesamoid resulting in pain under the first metatarsophalangeal joint often presenting in young female athletes. There is overlap of stress fracture, nonunion, and AVN that makes defining the diagnosis difficult but the treatment and outcomes are similar. The most reliable operative treatment used for AVN of the sesamoid is an accumulation of anatomic and mechanical factors with repetitive microtrauma. Nonoperative modalities are designed to offload the sesamoid. The only operative treatment used for AVN of the sesamoid is excision of the involved bone, which results most commonly in complete patient satisfaction.
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Affiliation(s)
- Kimberly Bartosiak
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 Euclid Avenue, St Louis, MO 63110, USA
| | - Jeremy J McCormick
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 Euclid Avenue, St Louis, MO 63110, USA.
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31
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Abstract
This article reviews the imaging aspects relevant to ligamentous instabilities of the foot and ankle with a focus on MRI and ultrasound imaging. A pictorial review of the anatomy of the medial and lateral ankle ligaments, syndesmosis, spring ligament, Lisfranc complex, hallux sesamoid complex, and lesser toe plantar plate as seen on MRI is presented. Selected cases of ligamentous pathology relevant to foot and ankle instability are presented. The value of imaging in the assessment of foot and ankle instability is reviewed.
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Affiliation(s)
- Peter Salat
- Department of Radiology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada; Mayfair Diagnostics, 6707 Elbow Drive Southwest 132, Calgary, Alberta T2V 0E3, Canada.
| | - Vu Le
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Mark E Cresswell
- Department of Radiology, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
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Abstract
Turf toe injuries can be a disabling if not recognized and treated early. A high index of suspicion, based on the mechanism of injury and appropriate imaging, helps in the timely diagnosis. These injuries are frequently known to occur on artificial playing surfaces, because of the increased traction at the shoe-surface interface. Stress and instability testing are key components to assess the need for surgical intervention. Accurate timely diagnosis and treatment can allow full return to physical activities for most athletes, back to their pre-injury level.
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Abstract
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
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Affiliation(s)
| | | | - Matthew Welck
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, UK
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Abstract
BACKGROUND Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. METHODS We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. RESULTS The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. CONCLUSION Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kenneth Smith
- 1 University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Norman Waldrop
- 2 American Sports Medicine Institute, Birmingham, AL, USA
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Wannop JW, Killick A, Madden R, Stefanyshyn DJ. The influence of gearing footwear on running biomechanics. FOOTWEAR SCIENCE 2017. [DOI: 10.1080/19424280.2017.1342705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- John William Wannop
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Anthony Killick
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Ryan Madden
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Darren J Stefanyshyn
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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36
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Marchetti DC, Chang A, Ferrari M, Clanton TO. Turf Toe: 40 Years Later and Still a Problem. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Linklater JM, Hayter CL, Vu D. Imaging of Acute Capsuloligamentous Sports Injuries in the Ankle and Foot: Sports Imaging Series. Radiology 2017; 283:644-662. [DOI: 10.1148/radiol.2017152442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- James M. Linklater
- From Castlereagh Imaging, 60 Pacific Hwy, St Leonards, Sydney, NSW, Australia 2065 (J.M.L., C.L.H.); and Department of Anatomy, School of Medical Science, University of Notre-Dame Australia, Sydney, Australia (D.V.)
| | - Catherine L. Hayter
- From Castlereagh Imaging, 60 Pacific Hwy, St Leonards, Sydney, NSW, Australia 2065 (J.M.L., C.L.H.); and Department of Anatomy, School of Medical Science, University of Notre-Dame Australia, Sydney, Australia (D.V.)
| | - Dzung Vu
- From Castlereagh Imaging, 60 Pacific Hwy, St Leonards, Sydney, NSW, Australia 2065 (J.M.L., C.L.H.); and Department of Anatomy, School of Medical Science, University of Notre-Dame Australia, Sydney, Australia (D.V.)
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38
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Nery C, Baumfeld D, Umans H, Yamada AF. MR Imaging of the Plantar Plate. Magn Reson Imaging Clin N Am 2017; 25:127-144. [DOI: 10.1016/j.mric.2016.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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39
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Ribbans WJ, Hintermann B. Hallucal Sesamoid Fractures in Athletes: Diagnosis and Treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.orthtr.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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40
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Abstract
A turf toe injury encompasses a wide spectrum of traumatic problems that occur to the first metatarsophalangeal joint. Most of these injuries are mild and respond well to nonoperative management. However, more severe injuries may require surgical management, including presence of diastasis or retraction of sesamoids, vertical instability, traumatic hallux valgus deformity, chondral injury, loose body, and failed conservative treatment.
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Affiliation(s)
- Lyndon W Mason
- Foot and Ankle Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK.
| | - Andrew P Molloy
- Foot and Ankle Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
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Stefanyshyn DJ, Wannop JW. The influence of forefoot bending stiffness of footwear on athletic injury and performance. FOOTWEAR SCIENCE 2016. [DOI: 10.1080/19424280.2016.1144652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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42
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Wannop JW, Stefanyshyn DJ. Special issue: Bending stiffness: performance and injury effects. FOOTWEAR SCIENCE 2016. [DOI: 10.1080/19424280.2016.1181947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Drakos MC, Fiore R, Murphy C, DiGiovanni CW. Plantar-plate disruptions: "the severe turf-toe injury." three cases in contact athletes. J Athl Train 2015; 50:553-60. [PMID: 25695855 DOI: 10.4085/1062-6050-49.6.05] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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.
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Affiliation(s)
- Mark C Drakos
- Department of Orthopedics, Hospital for Special Surgery, New York, NY; Departments of
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44
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Favinger JL, Porrino JA, Richardson ML, Mulcahy H, Chew FS, Brage ME. Epidemiology and imaging appearance of the normal Bi-/multipartite hallux sesamoid bone. Foot Ankle Int 2015; 36:197-202. [PMID: 25237171 DOI: 10.1177/1071100714552484] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Turf toe is a hyperextension injury of the hallux metatarsophalangeal joint that can be difficult to diagnose on physical examination and imaging. Diastasis of the bi- or multipartite sesamoid of the hallux has been implicated as 1 potential radiographic finding of turf toe injury, and when present may require operative management. However, the normal interval for the bi-/multipartite sesamoid has not yet been established. METHODS A total of 671 foot radiograph series were reviewed in effort to quantify the dominant interval of the bi-/multipartite sesamoid bone with respect to potential influencing factors including right versus left foot, medial and/or lateral sesamoid involvement, patient age and gender, and weight versus non-weight-bearing radiograph technique. RESULTS The prevalence of a bi-/multipartite hallux sesamoid was 14.3% in our population. The dominant sesamoid interval ranged from 0-2 mm, with an average of 0.79 mm. CONCLUSION We conclude that sesamoid diastasis should be considered, in the appropriate clinical setting, when the sesamoid interval is greater than 2 mm on a routine AP radiograph of the foot. LEVEL OF EVIDENCE Level III, comparative study.
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45
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Turf toe and sesamoiditis: what the radiologist needs to know. Clin Imaging 2014; 39:380-9. [PMID: 25482355 DOI: 10.1016/j.clinimag.2014.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/08/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022]
Abstract
The first metatarsophalangeal (MTP) joint complex is a critical weight-bearing structure important to biomechanics. An acute dorsiflexion injury, named "turf toe," is common among American football and soccer players. "Sesamoiditis" is a name often given for pain arising from the hallux sesamoids in the absence of acute trauma, and may result from a variety of causes. The first MTP joint complex can also be affected by degenerative or inflammatory arthritis, infarct, and infection. This review article will cover the anatomy and biomechanics of the first MTP joint complex, its patterns of injury and pathology, imaging techniques, and management.
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46
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Faltus J, Mullenix K, Moorman CT, Beatty K, Easley ME. Case series of first metatarsophalangeal joint injuries in division 1 college athletes. Sports Health 2014; 6:519-26. [PMID: 25364484 PMCID: PMC4212353 DOI: 10.1177/1941738114527546] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Context: Injuries of the first metatarsophalangeal (hallux MP) joint can be debilitating in the athletic population. Turf toe and plantar plate injuries are typically diagnosed similarly. However, variance in injury mechanism as well as compromised integrity of soft tissue and ligamentous structures make it difficult to accurately diagnose specific hallux MP injuries. Recent literature has supported the use of both radiographic imaging and the Lachman test as reliable indicators of joint instability in the presence of hallux MP injuries. To date, research supporting specific rehabilitation interventions and return-to-play decision making for hallux MP injuries has been limited to case studies and suggested guidelines from literature reviews. There is limited evidence suggesting specific criteria for surgical and nonsurgical decision making in conjunction with rehabilitation progressions to return an athlete to sport when managing hallux MP injuries. Evidence Acquisition: A literature search was performed using Medline, PubMed, and Google Scholar to find and review articles from 1970 to 2013 that addressed the basic anatomy of the plantar plate, injuries to this anatomical structure, and the evaluation, diagnosis, surgical and nonsurgical management, and rehabilitation of these injuries, specifically in the athletic population. Medical information for each case was gathered from electronic medical records from the individual athletes cited in this case series, which included imaging reports, rehabilitation documentation, and both evaluation and surgical reports. No statistical analysis was used. Study Design: Case series. Level of Evidence: Level 4. Results: Treatment plans for each case varied depending on surgical and nonsurgical intervention and rehabilitation outcomes. However, each athlete was able to return to sports-specific activities. Conclusion: Successful outcomes for hallux MP injuries are contingent on thorough evaluation, appropriate clinical decision making with regard to surgical versus nonsurgical treatment planning, and a multidisciplinary team approach for ensuring a safe return to sport. Strength-of-Recommendation Taxonomy (SORT): C.
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Affiliation(s)
| | - Kerry Mullenix
- Duke Sports Medicine, Department of Physical and Occupational Therapy, Duke Athletics, Durham, North Carolina
| | - Claude T Moorman
- Sports Medicine Section, Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kyle Beatty
- Duke Sports Medicine, Department of Physical and Occupational Therapy, Duke Athletics, Durham, North Carolina
| | - Mark E Easley
- Sports Medicine Section, Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
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Canales MB, DeMore M, Bowen MF, Ehredt DJ, Razzante MC. Fact or fiction? Iatrogenic hallux abducto valgus secondary to tibial sesamoidectomy. J Foot Ankle Surg 2014; 54:82-8. [PMID: 25441270 DOI: 10.1053/j.jfas.2014.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Indexed: 02/03/2023]
Abstract
First ray function and hallux misalignment after isolated tibial sesamoidectomy have been topics of debate. Although sesamoidectomy has been proved to be effective in the relief of sesamoid pain, many foot and ankle surgeons remain hesitant to perform the procedure fearing a possible joint perturbation. To our knowledge, the present study is the first to evaluate both laboratory and clinical evidence of the association between isolated tibial sesamoidectomy and hallux abducto valgus deformity. The bench study consisted of 10 cadaveric limbs that were dissected and prepared for testing. Controlled valgus loads were applied before and after tibial sesamoidectomy. No significant difference was found in the joint position after sesamoidectomy in both the rectus (p = .36) and the dorsiflexed (p = .062) positions. The clinical evaluation consisted of a retrospective cohort of 5 females; all of whom underwent isolated tibial sesamoidectomy. The pre- and postoperative radiographs and self-reported pain scores (visual analog scale) were compared. None of the patients developed a postoperative hallux abducto valgus deformity. Neither the hallux abductus angle (p = .180) nor the intermetatarsal angle 1-2 (p = .180) changed significantly in the postoperative setting. The visual analog scale pain scores changed from a mean of 6.8 to 1, a significant difference (p = .042). Based on our observations and clinical experience, we believe that isolated tibial sesamoidectomy does not have a significant effect on the position of the first metatarsophalangeal joint when meticulous surgical technique is used to excise the sesamoid. Isolated tibial sesamoidectomy can provide substantial pain relief and appears to be a safe treatment for a variety of conditions affecting the tibial sesamoid.
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Affiliation(s)
- Michael B Canales
- Private Practice, St. Vincent Medical Group, Rockside Physician's Center, Independence, OH; Associate Director, PMSR/RRA Residency Training Program, Department of Orthopedic Surgery, St. Vincent Charity Medical Center, Cleveland, OH; and Professor, Department of Surgery, Kent State University College of Podiatric Medicine, Independence, OH
| | - Matthew DeMore
- Adjunct Faculty, Kent State University College of Podiatric Medicine, Independence, OH; and Private Practice, Beachwood, OH
| | | | - Duane J Ehredt
- Postgraduate Year 3 Resident, PMSR/RRA Residency Training Program, St. Vincent Charity Medical Center, Cleveland, OH.
| | - Mark C Razzante
- Postgraduate Year 2 Resident, PMSR/RRA Residency Training Program, St. Vincent Charity Medical Center, Cleveland, OH
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48
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Lucas DE, Philbin T, Hatic S. The plantar plate of the first metatarsophalangeal joint: an anatomical study. Foot Ankle Spec 2014; 7:108-12. [PMID: 24572212 DOI: 10.1177/1938640014522095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The plantar plate of the first metatarsophalangeal (MP) joint is a critical structure of the forefoot that has been identified as a major stabilizer within the capsuloligamentous complex. Many studies have clarified and documented the anatomy of the lesser toe MP plantar plates, but few have looked closely at the anatomy of the first MP joint. Ten cadaveric specimens were examined to identify and document the objective anatomic relationship of the plantar plate, tibial sesamoid, and surrounding osseus structures. The average distance of the plantar plate distal insertion from the joint line into the proximal phalanx was 0.33 mm. The plantar plate was inserted into the metatarsal head on average 17.29 mm proximal from the joint line. The proximal aspect of the sesamoid was 18.55 mm proximal to the distal attachment of the plantar plate to the phalanx. The distal aspect of the sesamoid averaged 4.69 mm away from the distal attachment into the proximal phalanx. The footprint of the distal plate insertion was on average 6.33 mm in length in the sagittal plane. The authors hope that these objective data measures can aid in the understanding and subsequent surgical repair of this important forefoot structure.
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49
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Roche AJ, Calder JD. An atraumatic turf toe in an elite soccer player--a stress related phenomenon? Foot Ankle Surg 2014; 20:71-3. [PMID: 24480505 DOI: 10.1016/j.fas.2013.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/18/2013] [Accepted: 09/11/2013] [Indexed: 02/04/2023]
Abstract
Plantar plate injuries to the hallux in elite athlete could potentially be career threatening. Reports in the literature are invariably linked to a significant traumatic episode. The occurrence of an atraumatic severe plantar plate injury in the presence of a bipartite sesamoid may suggest a stress related phenomenon. We present a case in an elite soccer player who was treated surgically and returned to top-level competition. The case is reported in detail and differences to other reports in the literature discussed.
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Affiliation(s)
- Andrew J Roche
- Department of Trauma and Orthopaedic Surgery, Chelsesa and Westminster Hospital, Fulham Road, London SW10 9TR, United Kingdom.
| | - James D Calder
- Department of Trauma and Orthopaedic Surgery, Chelsesa and Westminster Hospital, Fulham Road, London SW10 9TR, United Kingdom.
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50
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George E, Harris AHS, Dragoo JL, Hunt KJ. Incidence and risk factors for turf toe injuries in intercollegiate football: data from the national collegiate athletic association injury surveillance system. Foot Ankle Int 2014; 35:108-15. [PMID: 24334272 DOI: 10.1177/1071100713514038] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Turf toe is the general term for a sprain of the first metatarsophalangeal (MTP) joint complex. Previously attributed to shoe design and artificial turf, the incidence of turf toe injury has been thought to decline with the advent of newer turf designs. However, the current incidence and epidemiology remain unknown as the majority of the literature consists of small series and addresses diagnosis and treatment rather than epidemiology and prevention. METHODS We examined data from the NCAA's Injury Surveillance System (ISS) for 5 football seasons (2004-2005 through 2008-2009), including all preseason, regular season, and postseason practice and competition data. The incidence, epidemiology, and risk factors for turf toe injury, defined as injury to the connective tissue of the first MTP joint, plantar plate complex, and/or sesamoid fracture, were determined. RESULTS The overall incidence of turf toe injuries in NCAA football players was 0.062 per 1000 athlete-exposures (A-Es; 95% CI 0.052, 0.072). Athletes were nearly 14 times more likely to sustain the injury during games compared to practice, with a mean days lost due to injury of 10.1 (7.9, 12.4). Fewer than 2% of turf toe injuries required operative intervention. There was a significantly higher injury rate on third-generation artificial surfaces compared to natural grass (0.087 per 1000 A-E [0.067, 0.11] vs 0.047 per 1000 A-E [0.036, 0.059]). The majority of injuries occurred as a result of contact with the playing surface (35.4%) or contact with another player (32.7%), and running backs and quarterbacks were the most common positions to suffer turf toe injury. CONCLUSION Our data suggest a significantly higher incidence of turf toe injuries during games, a greater susceptibility among running backs and quarterbacks, and a significant contribution of playing surface to risk of injury. Though turf toe injuries may be less common that previously reported in elite football players, these injuries warrant appropriate acute and long-term management to prevent long-term dysfunction. LEVEL OF EVIDENCE Level IV, case series.
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