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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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2
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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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3
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Gorica Z, McFarland K, Lewis JS, Schweitzer KM, Vap AR. Surgical Repair of Posttraumatic Hallux Valgus Deformity in a Collegiate Football Player: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00012. [PMID: 36099514 DOI: 10.2106/jbjs.cc.22.00023] [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: 06/15/2023]
Abstract
CASE We report a rare case of posttraumatic hallux valgus in a collegiate football player after an acute medial collateral ligament tear of the first metatarsophalangeal joint. The patient was treated with a modification of the modified McBride technique, using an all-suture anchor for the medial ligamentous complex repair. There was return to sport at 5 months and a Foot and Ankle Outcome Score of 95% at 10 months. CONCLUSION A modified McBride procedure further modified with the utilization of an all-suture anchor for the medial ligamentous complex repair can result in correction of deformity, pain-free movement and return to sport.
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Affiliation(s)
- Zylyftar Gorica
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | | | - John S Lewis
- Louisville Orthopedic Clinic, Louisville, Kentucky
| | - Karl M Schweitzer
- Department of Orthopaedic Surgery, Duke University, Raleigh, North Carolina
| | - Alexander R Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
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4
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Gorica Z, McFarland K, Lewis JS, Schweitzer KM, Vap AR. Post-Traumatic Hallux Valgus: A Modified Surgical Technique. Arthrosc Tech 2022; 11:e37-e42. [PMID: 35127427 PMCID: PMC8807717 DOI: 10.1016/j.eats.2021.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/29/2021] [Indexed: 02/03/2023] Open
Abstract
Post-traumatic hallux valgus, a turf toe variant, is a rare, yet limiting injury. According to the literature, the deformity has been associated with acute medial collateral ligament tears, turf toe variant injuries, Lisfranc injury patterns, and first metatarsal fractures. There have been few documented cases of post-traumatic hallux valgus secondary to medial collateral ligament tears, and the treatment has been variable. Some authors have described direct end-to-end repair of the ligament to address the deformity, while others have described a modified McBride bunionectomy involving a Silver bunionectomy, lateral soft tissue release, and medial capsular and ligamentous repair. We propose a modified technique similar to the modified McBride bunionectomy, however, with the use of an all-suture anchor in the medial capsular and ligamentous repair. Our belief is that the all-suture anchor will allow for a stronger repair that will meet the physical demands of everyday ambulation and athletic participation. We used this technique in an individual who had evidence of a medial ligamentous complex injury of the hallux on MRI and failed conservative management. Postoperatively, the patient is immobilized until they can begin working on range of motion, strengthening, and finally to achieve return to full activity and sports.
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Affiliation(s)
- Zylyftar Gorica
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
- Address correspondence to Zylyftar Gorica, M.D., Department of Orthopaedic Surgery, Virginia Commonwealth University, 1200 East Broad St., 9th Fl., Box 980153, Richmond, VA 23298, U.S.A.
| | - Kimberly McFarland
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - John S. Lewis
- Louisville Orthopedic Clinic, Louisville, Kentucky, U.S.A
| | - Karl M. Schweitzer
- Department of Orthopaedic Surgery, Duke University, Raleigh, North Carolina, U.S.A
| | - Alexander R. Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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5
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Fernandez A, Basselerie H, Assabah B, Ancelin D. Post traumatic medial instability of the MTP1 joint and ensuing surgical reconstruction: A case report. Foot Ankle Surg 2022; 28:134-137. [PMID: 33674194 DOI: 10.1016/j.fas.2021.02.003] [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: 07/05/2020] [Revised: 01/12/2021] [Accepted: 02/03/2021] [Indexed: 02/04/2023]
Abstract
Sport injuries of the first metatarsophalangeal joint are well described, especially with traumatic hallux valgus and turf toe reports. However, there is no description of infraclinical medial laxity and following articular disorders. We report the case of a thirty-year-old runner who suffered a sprain initially treated with retentive dressing and local injection. He developed microinstability of the first ray and quickly a bone cyst, pushing us to suggest surgical treatment. After one year of follow up after surgery, he returned to previous high-performance sport. This case highlights the probable undervaluation of post traumatic stability of the first metatarsophalangeal joint, and its potential consequences for the return to sport. LEVEL OF CLINICAL EVIDENCE: Level 4.
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Affiliation(s)
- A Fernandez
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, 31059, France.
| | - H Basselerie
- Department of Medical Imaging, Hôpital Pierre-Paul Riquet, Toulouse, 31059, France
| | - B Assabah
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, 31059, France
| | - D Ancelin
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, 31059, France; I2R, Institut de Recherche Riquet, Toulouse, 31059, France
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6
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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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7
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Koós Z, Sisák K. Novel dynamic stabilization method for medial instability of the first metatarsophalangeal joint. J Orthop Surg (Hong Kong) 2020; 27:2309499019877687. [PMID: 31610745 DOI: 10.1177/2309499019877687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Medial collateral ligament injury of the first metatarsophalangeal (MTP) joint is rare. If it is missed, chronic instability and traumatic hallux valgus develop, requiring surgical treatment. Different methods have been reported in the limited available literature aiming to restore the balance between the lateral and medial stabilizers by tightening the medial joint capsule with or without additional tendon graft. Our described method utilizes a suture button device (Mini TightRope, Arthrex, Naples, Florida) for reconstruction. This device applies tension to hold the hallux in the correct position, providing stability. Relevant diagnostic regimen, surgical technique, and postoperative care are described, along with a case of a handball player who underwent this procedure. He continues to perform at the same level 38 months postoperatively. Mini TightRope fixation for chronic medial first MTP instability has not been reported. It does not require postoperative immobilization and allows faster return to sport, so it seems superior to other methods when treating athletes.
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Affiliation(s)
- Zoltán Koós
- Department of Orthopaedics, Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Krisztián Sisák
- Department of Orthopaedics, University of Szeged, Szeged, Hungary
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8
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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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9
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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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10
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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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Lui TH. First metatarsophalangeal arthroscopy in patients with post-traumatic hallux valgus. Foot (Edinb) 2015; 25:270-6. [PMID: 26362238 DOI: 10.1016/j.foot.2015.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 06/21/2015] [Accepted: 07/31/2015] [Indexed: 02/04/2023]
Abstract
Post-traumatic hallux valgus is relatively rare and has been reported after rupture of the medial collateral ligament of the first metatarsophalangeal (MTP-1) joint; Lisfranc joint injury; turf toe injury; medial plantar nerve entrapment secondary to tibial fracture or first metatarsal fracture. Post-traumatic hallux valgus after medial collateral ligament injury has a high incidence of MTP-1 pathology. Detailed history and clinical examination can facilitate differentiation of the source(s) of the patient's symptoms and assist accurate formulation of the surgical plan. First, MTP arthroscopy is a feasible diagnostic and therapeutic tool to manage the MTP-1 joint pain in hallux valgus following injury to the MTP-1 joint.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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12
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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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13
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Abstract
Context: Despite an increasing awareness of turf toe injury, confusion still exists regarding the anatomy, mechanism, diagnosis, and treatment of this hyperextension injury to the hallux metatarsophalangeal (MTP) joint. Evidence Acquisition: This article reviews the anatomy, diagnosis, and treatment algorithm for turf toe injury by reviewing relevant studies and presenting information useful to clinicians, therapists, and athletic trainers. A literature search was performed by a review of PubMed and OVID articles published from 1976 to July 2010. Results: Grade I injury is a sprain or attenuation of the plantar capsular ligamentous complex of the hallux MTP joint; athletes are typically able to return to play as tolerated. Grade II injury is a partial rupture of the plantar soft tissue structures of the hallux MTP joint, typically requiring about 2 weeks to recover. Grade III injury is a complete rupture of the plantar structures of the hallux MTP joint, requiring at least 10 to 16 weeks to recover. Some complete ruptures require surgical repair. Conclusion: With accurate diagnosis, athletes can have an appropriate treatment plan, and their expectations can be tempered to the degree of injury. Careful management may allow successful return to play at a preinjury level of participation.
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14
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Kadakia AR, Molloy A. Current concepts review: traumatic disorders of the first metatarsophalangeal joint and sesamoid complex. Foot Ankle Int 2011; 32:834-9. [PMID: 22049873 DOI: 10.3113/fai.2011.0834] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Anish R Kadakia
- University of Michigan, Orthopaedic Surgery, 2098 South Main Street, Ann Arbor, MI 48103, USA.
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15
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Lee DK, Mulder GD, Schwartz AK. Hallux, sesamoid, and first metatarsal injuries. Clin Podiatr Med Surg 2011; 28:43-56. [PMID: 21276517 DOI: 10.1016/j.cpm.2010.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hallux, sesamoid, and first metatarsal injuries are common foot injuries and have implications in the biomechanical functionality of the first ray and foot. They are essential for propulsion in normal gait. As part of the first ray, it is an important contributor to normal locomotion. Any structure disruption or injury can create angular changes or arthritis, which can have biomechanical implications, including pain, disability, compensation, swelling, and reduced range of motion.
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Affiliation(s)
- Daniel K Lee
- Department of Orthopaedic Surgery, School of Medicine, University of California-San Diego, 350 Dickinson Street, San Diego, CA 92103-8894, USA.
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16
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McCormick JJ, Anderson RB. Rehabilitation following turf toe injury and plantar plate repair. Clin Sports Med 2010; 29:313-23, ix. [PMID: 20226323 DOI: 10.1016/j.csm.2009.12.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The evaluation and diagnosis of turf toe injuries is improving as it becomes a more recognized pattern of injury to the hallux metatarsophalangeal joint. With an understanding of the anatomy of the injury and the ability to focus on important diagnostic and radiographic clues, turf toe can be diagnosed, assessed, and treated accurately, with surgical repair when indicated. Regardless of the grade of injury, rehabilitation of the athlete under the guidance of a physical therapist or athletic trainer is critical to complete recovery. With appropriate care, athletes can successfully return to play and efficiently reach their preinjury level of participation.
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Affiliation(s)
- Jeremy J McCormick
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Washington University, 14532 South Outer Forty Drive, Chesterfield, St Louis, MO 63017, USA.
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19
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McCormick JJ, Anderson RB. The great toe: failed turf toe, chronic turf toe, and complicated sesamoid injuries. Foot Ankle Clin 2009; 14:135-50. [PMID: 19501799 DOI: 10.1016/j.fcl.2009.01.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Turf toe injuries and sesamoid injuries are challenging because of the variety of causes that exist as sources of pain. Through a systematic approach to evaluation, injuries to the hallux metatarsophalangeal joint can be diagnosed properly. Correct diagnosis leads to accurate and efficient treatment. If conservative measures fail, operative interventions are available to relieve pain and restore function. With careful surgical technique and appropriate postoperative management, athletes can return to play and efficiently reach their pre-injury level of participation.
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Acute traumatic hallux valgus deformity in an adolescent that resolved with appropriate splintage: a case report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2007. [DOI: 10.1007/s00590-007-0247-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The first ray differs from the other rays in its position and its importance with weight bearing. Because it is a critical structure in the formation of the tripod of the foot, injuries to this ray can cause critical alterations in the biomechanics of the foot. This allows for pathologic weight-bearing points of contact and deformity that lead to a disabling gait. Physicians who are involved in the care of the foot and ankle should be familiar with the spectrum of injuries that concern the first ray. These injuries, their management, and sequelae are reviewed.
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Affiliation(s)
- John D Maskill
- Grand Rapids Medical Education and Research Center/Michigan State University, Orthopaedic Surgery Residency Program, 300 Lafayette, Grand Rapids, MI 49503, USA.
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Mohana-Borges AVR, Theumann NH, Pfirrmann CWA, Chung CB, Resnick DL, Trudell DJ. Lesser metatarsophalangeal joints: standard MR imaging, MR arthrography, and MR bursography--initial results in 48 cadaveric joints. Radiology 2003; 227:175-82. [PMID: 12668744 DOI: 10.1148/radiol.2271020283] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To delineate the normal magnetic resonance (MR) imaging anatomy of the lesser metatarsophalangeal (MTP) joints in a cadaveric model and compare the MR arthrographic and MR bursographic findings with the standard MR imaging findings. MATERIALS AND METHODS T1-weighted spin-echo MR imaging of 48 lesser MTP joints of 12 cadaveric feet was performed. The specimens were subsequently evaluated with MR arthrography, MR bursography, or both examinations. Musculoskeletal radiologists evaluated standard MR images to determine the normal appearances of the joint structures, especially the fibrous capsule, plantar plate, and collateral ligament complex (CLC). Signal intensity, morphology, joint thickness, relationships with adjacent structures, and best plane for analysis were analyzed. The contrast material-enhanced (ie, arthrographic and bursographic) MR imaging findings were compared with the standard MR imaging findings. RESULTS The coronal plane was best for simultaneous depiction of the fibrous capsule, plantar plate, and collateral ligament complex and for assessment of the relationship between the CLC and the plantar plate. The sagittal plane was best for analysis of the bone attachments of the plantar plate and the transverse plane for evaluation of the CLC attachment sites in the phalanges. MR arthrography enabled identification of the bare areas and recesses of the joints, better delineation of the plantar plate articular surface, and better evaluation of the integrity of the soft-tissue components of the joints. Compared with the other examinations, MR bursography did not help improve these evaluations. CONCLUSION MR imaging is an excellent examination for delineating the anatomy of the lesser MTP joints. Compared with standard MR imaging, only MR arthrography helps improve visualization of the fibrous capsule, plantar plate, and CLC of the lesser MTP joints.
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Affiliation(s)
- Aurea V R Mohana-Borges
- Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
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Theumann NH, Pfirrmann CWA, Mohana Borges AVR, Trudell DJ, Resnick D. Metatarsophalangeal joint of the great toe: normal MR, MR arthrographic, and MR bursographic findings in cadavers. J Comput Assist Tomogr 2002; 26:829-38. [PMID: 12439324 DOI: 10.1097/00004728-200209000-00029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To demonstrate the normal anatomy of the metatarsophalangeal (MTP) joint of the great toe with MR imaging, MR arthrography, and MR bursography. MATERIALS AND METHODS MR images of 12 cadaveric MTP joints of the great toe were obtained before and after arthrography, busography, or both. The MR appearances of all articular and periarticular structures were analyzed and correlated with those seen on anatomic sections. RESULTS The sesamoid bones and ligaments, the deep transverse metatarsal ligament, and the tendon attachments of the abductor and adductor hallucis muscles were seen best in the coronal plane. The sagittal plane was best for evaluating the plantar plate, the articular cartilage, and the tendon attachments of the flexor and extensor hallucis brevis muscles. The main collateral ligaments were evaluated best in the axial plane. MR arthrography improved the visualization of all articular and periarticular structures except the collateral ligament complexes. MR bursography did not enhance the visualization of these structures. CONCLUSIONS MR imaging and MR arthrography allow accurate visualization of the important anatomic structures in and about the MTP joint of the great toe.
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Affiliation(s)
- Nicolas H Theumann
- Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
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Fabeck LG, Zekhnini C, Farrokh D, Descamps PY, Delincé PE. Traumatic hallux valgus following rupture of the medial collateral ligament of the first metatarsophalangeal joint: a case report. J Foot Ankle Surg 2002; 41:125-8. [PMID: 11995833 DOI: 10.1016/s1067-2516(02)80037-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Metatarsophalangealjoint injuries of the great toe are receiving increasing attention in athletes. Significant disability and long-term morbidity can result from these focal injuries. The entity known as turf-toe is widely recognized. Rupture of the medial collateral ligament of the first metatarsophalangeal joint is less common. A case of traumatic rupture of the medial collateral ligament in the great toe of a soccer player, which progressed to hallux valgus deformity, is presented.
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Affiliation(s)
- Laurent G Fabeck
- Department of Orthopedic Surgery, Saint-Pierre Universitary Hospital, Brussels, Belgium.
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