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1st MTPJ medial collateral ligament rupture

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Matrix, Feb 9, 2011.

  1. Matrix

    Matrix Member

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    Hi everyone,

    I have a patient (soccer player) with this !st MTPJ medial collateral ligament rupture and am interested to know of any pearls of wisdom in the treatment of this injury. Conservative management versus surgical etc. I am yet to get further details on the injury/see the patient yet, so cannot give further details.

    Thanks in advance!
  2. I had a little look for info for you did not find anything much, as for what I think surgical correction there maybe a big chance of Hallux Valgus deformity due to the change in internal stability of the 1st MTPJ.

    ie there will be reduced resistance to abduction of the hallux.

    Maybe the below helps ?

  3. efuller

    efuller MVP

    I've always wondered about the surgical repair of torn ligaments. Either way the healing process has to create a ligament that will function to appropriately limit motion. By appropriate I mean that it doesn't limit the motion you want (adhesions) and it does limit the motion you don't want (bunion formation.) I wonder if healing from a surgical wound and tear is any different than healing from just the tear. Yes, the sutures in the ligament will help limit abnormal motion, but are they necessary? How strong is a sutured ligament? At 2 weeks? At 6 weeks? How strong is an unsutured ligament at 6 weeks? Interesting questions.

    If it were my foot, and money and rehab time was no object, I'd want a continuous passive motion machine to move it in a controlled manner a couple of times every other hour. Although bandaging it in a straight position and having someone gently guide it through the correct range of motion every couple of days might be just fine. It's been a while since I read up on continuous passive motion. There is a lot out there on the knee. I'd bet that it would apply.

  4. Matrix

    Matrix Member

    Thanks for the replies!

    It is predominantly the ligament that is damaged, with not too much else which is a positive. Seems like a primarily valgus force (foot planted and slide tackle from the medial aspect of the hallux) that has caused the injury.

    I have done a thorough literature search and come up with limited info on the 1st MTPJ, but as you say Eric, there is some good research on MCL injuries & rehab at the knee. I must admit that I do favour the conservative management based on what I have seen in the research so far Mike - thanks for posting that article up though, I will have a good read of it.

    Plan at this stage is to focus on conservative management with the usual physical therapies and an aircast for some relative rest until we have some reduction in pain levels. Also going to try a HAV night splint as he already had a mild stage 1 HAV and I would assume holding the joint in a rectus position would be beneficial to the healing process.

    Will definitely work on some passive motion - currently active motion is very restricted as you would expect.

    Thanks again :)
  5. In a professsional soccer player, surgical repair should be done in the off-season to prevent hallux valgus deformity development. Surgery would probably require only 4 weeks off of soccer. In a non-professional, conservative care with taping the toe in proper alignment and/or placing a 1/4" (6 mm) toe spacer pad should work well, but would require probably 3-4 months of this.

    Hope this helps.

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