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.
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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.
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