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1st ray plantar plate tear

Discussion in 'Biomechanics, Sports and Foot orthoses' started by JackieSmith, Nov 1, 2018.

  1. JackieSmith

    JackieSmith Member

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    Hello. I have an active male in his 30's. Works in construction. 6 month history of pain ?in right hallux. Suffered acute surfing injury 2 weeks ago and has not been able to walk on right 1st plantar metatarsal head since then.
    There is bilateral structural hallux limitus. No noticeable heat or swelling. The digit is not 'floating' when weightbearing.

    Ultrasound shows 4.8mm tear to the right 1st plantar plate. Flexor and extensor tendons are preserved.
    Xray shows normal appearance to sesamoids and the sesamoids are in a symmetrical position to contralateral with hallux dorsiflexion. Minor degenerative changes in interphalangeal joints with subchondral cysts with sclerotic margins.

    This is the first time I have come across a plantar plate tear to the 1st. I have advised to wear a stiff soled shoe (his work boots) rather than thongs, avoid barefoot walking, and to ice the area. I have also attempted to tape the hallux into plantarflexion as I would with a 2nd digit. Perhaps advise to look at a rocker sole runner eg.g Hokas?

    I would welcome any other pearls of wisdom as this is such an important joint to preserve good function. I have the facility to provide: rigid surgical shoe or aircast boot, custom orthotics or an off the shelf rigid shell which I could add met dome etc to if this would work for this location of injury?

    Thanks in advance for any advice.
  2. Hi.

    Carbon fibre with no dorsiflex rocker.

    Or walker most likely. I would go with the walker. If that works then stiff shoes or add the carbon fiber. Reduce the rocker and then if that step works custom devices that increase the dorsiflexion stiffness at the 1st MTPJ.

    Interesting case might also chat with a surgeon get their input
  3. Lab Guy

    Lab Guy Well-Known Member

    How do you develop turf toe in a foot with structural hallux limitus?
  4. JackieSmith

    JackieSmith Member

    Hi sorry only just seen your replies. I saw the patient shortly after my post. He declined a walker, boot or surgical shoe. His pain has improved and is now 3/10 and he can weightbear normally. No floating toe. We have gone with strapping and footwear advice (he came in again wearing thongs). He is back in next week and will consider orthotics. Could you explain the 'carbon fibre with no dorsiflex rocker' - do you mean a carbon fibre mortons extension type device? Would orthoses be advisable even if he is still improving pain wise?
    Should we generally be guided by symptoms with regard to healing? Or follow up ultrasound/MRI? Same with surgical input- would that generally be guided by symptoms?

    Steven - In this instance the patient related the injury to getting his foot caught in rocks while surfing.

    Thanks again for any valuable input.

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