Presurgical Perspective and Postsurgical Evaluation of Plantar Plate and Turf Toe

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.

Keywords

turf toe - plantar plate - metatarsophalangeal capsuloligamentous injury - imaging

Publication History

Article published online:
15 February 2023

• References

• 1 Bowers Jr KD, Martin RB. Turf-toe: a shoe-surface related football injury. Med Sci Sports 1976; 8 (02) 81-83
• 2 George E, Harris AH, 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 (02) 108-115
• 3 York PJ, Wydra FB, Hunt KJ. Injuries to the great toe. Curr Rev Musculoskelet Med 2017; 10 (01) 104-112
• 4 McCormick JJ, Anderson RB. The great toe: failed turf toe, chronic turf toe, and complicated sesamoid injuries. Foot Ankle Clin 2009; 14 (02) 135-150
• 5 Linklater JM. Imaging of sports injuries in the foot. AJR Am J Roentgenol 2012; 199 (03) 500-508
• 6 Wilson L, Dimeff R, Miniaci A, Sundaram M. Radiologic case study. First metatarsophalangeal plantar plate injury (turf toe). Orthopedics 2005; 28 (04) 344 , 417–419
• 7 Nery C, Fonseca LF, Gonçalves JP. et al. First MTP joint instability—expanding the concept of “turf-toe” injuries. Foot Ankle Surg 2020; 26 (01) 47-53
• 8 Lievers WB, Adamic PF. Incidence and severity of foot and ankle injuries in men's collegiate American football. Orthop J Sports Med 2015; 3 (05) 2325967115581593
• 9 Coker TP, Arnold JA, Weber DL. Traumatic lesions of the metatarsophalangeal joint of the great toe in athletes. J Ark Med Soc 1978; 74 (08) 309-317
• 10 Clanton TO, Ford JJ. Turf toe injury. Clin Sports Med 1994; 13 (04) 731-741
• 11 Doty JF, Coughlin MJ. Turf toe repair: a technical note. Foot Ankle Spec 2013; 6 (06) 452-456
• 12 Childs SG. The pathogenesis and biomechanics of turf toe. Orthop Nurs 2006; 25 (04) 276-280 ; quiz 281–282
• 13 Stokes IA, Hutton WC, Stott JR, Lowe LW. Forces under the hallux valgus foot before and after surgery. Clin Orthop Relat Res 1979; (142) 64-72
• 14 Nigg BM, Yeadon MR. Biomechanical aspects of playing surfaces. J Sports Sci 1987; 5 (02) 117-145
• 15 Chiou D, Stupay KL, Waryasz G. Turf toe review. Foot Ankle Spec 2020; 13 (02) 161-168
• 16 Marchetti DC, Chang A, Ferrari M, Clanton TO. Turf toe: 40 years later and still a problem. Oper Tech Sports Med 2017; 25 (02) 99-107
• 17 Schein AJ, Skalski MR, Patel DB. et al. Turf toe and sesamoiditis: what the radiologist needs to know. Clin Imaging 2015; 39 (03) 380-389
• 18 Aper RL, Saltzman CL, Brown TD. The effect of hallux sesamoid excision on the flexor hallucis longus moment arm. Clin Orthop Relat Res 1996; (325) 209-217
• 19 Dedmond BT, Cory JW, McBryde Jr A. The hallucal sesamoid complex. J Am Acad Orthop Surg 2006; 14 (13) 745-753
• 20 Crain JM, Phancao JP. Imaging of turf toe. Radiol Clin North Am 2016; 54 (05) 969-978
• 21 Kadakia AR, Molloy A. Current concepts review: traumatic disorders of the first metatarsophalangeal joint and sesamoid complex. Foot Ankle Int 2011; 32 (08) 834-839
• 22 Richardson EG. Injuries to the hallucal sesamoids in the athlete. Foot Ankle 1987; 7 (04) 229-244
• 23 Hainsworth L. McKinley The management of turf toe—a systematic review. Baltic J Sport Health 2018; 110 (03) 25-37
• 24 Rodeo SA, O'Brien S, Warren RF, Barnes R, Wickiewicz TL, Dillingham MF. Turf-toe: an analysis of metatarsophalangeal joint sprains in professional football players. Am J Sports Med 1990; 18 (03) 280-285
• 25 VanPelt MD, Saxena A, Allen MA. Turf toe injuries. In: Saxena A. ed. Sports Medicine and Arthroscopic Surgery of the Foot and Ankle. London, UK: Springer; 2012
• 26 Hsu AR, Anderson RB. Foot and ankle injuries in American football. Am J Orthop 2016; 45 (06) 358-367
• 27 Mullis DL, Miller WE. A disabling sports injury of the great toe. Foot Ankle 1980; 1 (01) 22-25
• 28 Frey C, Andersen GD, Feder KS. Plantarflexion injury to the metatarsophalangeal joint (“sand toe”). Foot Ankle Int 1996; 17 (09) 576-581
• 29 Oloff LM, Schulhofer SD. Sesamoid complex disorders. Clin Podiatr Med Surg 1996; 13 (03) 497-513
• 30 Ryan AJ, Behling F, Garrick JG. et al. Artificial turf: pros and cons(round table). Phys Sports Med 1975; 3: 41-50
• 31 McCormick JJ, Anderson RB. Turf toe: anatomy, diagnosis, and treatment. Sports Health 2010; 2 (06) 487-494
• 32 Clough TM, Majeed H. Turf toe injury-current concepts and an updated review of literature. Foot Ankle Clin 2018; 23 (04) 693-701
• 33 Waldrop III NE, Zirker CA, Wijdicks CA, Laprade RF, Clanton TO. Radiographic evaluation of plantar plate injury: an in vitro biomechanical study. Foot Ankle Int 2013; 34 (03) 403-408
• 34 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 (02) 197-202
• 35 Feuerstein CA, Weil Jr L, Weil Sr LS, Klein EE, Fleischer A, Argerakis NG. Static versus dynamic musculoskeletal ultrasound for detection of plantar plate pathology. Foot Ankle Spec 2014; 7 (04) 259-265
• 36 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 (01) 112-116
• 37 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 (05) 553-560
• 38 Sahin N, Atici T, Bilgen SM, Bilgen OF. Turf toe in a taekwandoo player: case report. J Sports Sci Med 2004; 3 (02) 96-100
• 39 Mason LW, Molloy AP. Turf toe and disorders of the sesamoid complex. Clin Sports Med 2015; 34 (04) 725-739
• 40 Debnath UK, Hemmady MV, Hariharan K. Indications for and technique of first metatarsophalangeal joint arthroscopy. Foot Ankle Int 2006; 27 (12) 1049-1054
• 41 Clanton TO, Butler JE, Eggert A. Injuries to the metatarsophalangeal joints in athletes. Foot Ankle 1986; 7 (03) 162-176
• 42 Linklater JM, Hayter CL, Vu D. Imaging of acute capsuloligamentous sports injuries in the ankle and foot: sports imaging series. Radiology 2017; 283 (03) 644-662
• 43 Doty JF, Coughlin MJ. Metatarsophalangeal joint instability of the lesser toes and plantar plate deficiency. J Am Acad Orthop Surg 2014; 22 (04) 235-245
• 44 Nery C, Coughlin MJ, Baumfeld D, Mann TS. Lesser metatarsophalangeal joint instability: prospective evaluation and repair of plantar plate and capsular insufficiency. Foot Ankle Int 2012; 33 (04) 301-311
• 45 Linklater JM, Bird SJ. Imaging of lesser metatarsophalangeal joint plantar plate degeneration, tear, and repair. Semin Musculoskelet Radiol 2016; 20 (02) 192-204
• 46 Fernandes EA, Mann TS, Puchnick A. et al. Can ultrasound of plantar plate have normal appearance with a positive drawer test?. Eur J Radiol 2015; 84 (03) 443-449
• 47 Klein EE, Weil Jr L, Weil Sr LS, Knight J. The underlying osseous deformity in plantar plate tears: a radiographic analysis. Foot Ankle Spec 2013; 6 (02) 108-118
• 48 Coughlin MJ. Crossover second toe deformity. Foot Ankle 1987; 8 (01) 29-39
• 49 Coughlin MJ. Subluxation and dislocation of the second metatarsophalangeal joint. Orthop Clin North Am 1989; 20 (04) 535-551
• 50 Umans H, Srinivasan R, Elsinger E, Wilde GE. MRI of lesser metatarsophalangeal joint plantar plate tears and associated adjacent interspace lesions. Skeletal Radiol 2014; 43 (10) 1361-1368
• 51 Nery C, Umans H, Baumfeld D. Etiology, clinical assessment, and surgical repair of plantar plate tears. Semin Musculoskelet Radiol 2016; 20 (02) 205-213
• 52 Deland JT, Lee KT, Sobel M, DiCarlo EF. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int 1995; 16 (08) 480-486
• 53 Johnston III RB, Smith J, Daniels T. The plantar plate of the lesser toes: an anatomical study in human cadavers. Foot Ankle Int 1994; 15 (05) 276-282
• 54 Deland JT, Sung IH. The medial crossover toe: a cadaveric dissection. Foot Ankle Int 2000; 21 (05) 375-378
• 55 Sarrafian SK, Kelikian AS. Syndesmology. In: Sarrafian's Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. 3rd ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2011
• 56 Myerson MS, Jung HG. The role of toe flexor-to-extensor transfer in correcting metatarsophalangeal joint instability of the second toe. Foot Ankle Int 2005; 26 (09) 675-679
• 57 Bouché RT, Heit EJ. Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal joints: preliminary observations. J Foot Ankle Surg 2008; 47 (02) 125-137
• 58 Powless SH, Elze ME. Metatarsophalangeal joint capsule tears: an analysis by arthrography, a new classification system and surgical management. J Foot Ankle Surg 2001; 40 (06) 374-389
• 59 Barg A, Courville XF, Nickisch F, Bachus KN, Saltzman CL. Role of collateral ligaments in metatarsophalangeal stability: a cadaver study. Foot Ankle Int 2012; 33 (10) 877-882
• 60 Coughlin MJ, Schutt SA, Hirose CB. et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int 2012; 33 (02) 133-140
• 61 Mann TS, Nery C, Baumfeld D, Fernandes EA. Is second metatarsal protrusion related to metatarsophalangeal plantar plate rupture?. AJR Am J Roentgenol 2021; 216 (01) 132-140
• 62 Coughlin MJ, Baumfeld DS, Nery C. Second MTP joint instability: grading of the deformity and description of surgical repair of capsular insufficiency. Phys Sportsmed 2011; 39 (03) 132-141
• 63 Coughlin MJ. Crossover second toe deformity. Foot Ankle 1987; 8 (01) 29-39
• 64 Kaz AJ, Coughlin MJ. Crossover second toe: demographics, etiology, and radiographic assessment. Foot Ankle Int 2007; 28 (12) 1223-1237
• 65 Thompson FM, Hamilton WG. Problems of the second metatarsophalangeal joint. Orthopedics 1987; 10 (01) 83-89
• 66 Mulder JD. The causative mechanism in Morton's metatarsalgia. J Bone Joint Surg Br 1951; 33-B (01) 94-95
• 67 Coughlin MJ. Second metatarsophalangeal joint instability in the athlete. Foot Ankle 1993; 14 (06) 309-319
• 68 Maestro M, Besse JL, Ragusa M, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin 2003; 8 (04) 695-710
• 69 Hardy RH, Clapham JC. Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br 1951; 33-B [phone]
• 70 Gregg JM, Silberstein M, Schneider T, Kerr JB, Marks P. Sonography of plantar plates in cadavers: correlation with MRI and histology. AJR Am J Roentgenol 2006; 186 (04) 948-955
• 71 Gregg JM, Schneider T, Marks P. MR imaging and ultrasound of metatarsalgia–the lesser metatarsals. Radiol Clin North Am 2008; 46 (06) 1061-1078 , vi–vii
• 72 Gregg J, Silberstein M, Schneider T, Marks P. Sonographic and MRI evaluation of the plantar plate: a prospective study. Eur Radiol 2006; 16 (12) 2661-2669
• 73 Bartolomei FJ, Wertheimer SJ. Intermetatarsal neuromas: distribution and etiologic factors. J Foot Surg 1983; 22 (04) 279-282
• 74 Addante JB, Peicott PS, Wong KY, Brooks DL. Interdigital neuromas. Results of surgical excision of 152 neuromas. J Am Podiatr Med Assoc 1986; 76 (09) 493-495
• 75 Friscia DA, Strom DE, Parr JW, Saltzman CL, Johnson KA. Surgical treatment for primary interdigital neuroma. Orthopedics 1991; 14 (06) 669-672
• 76 Bennett GL, Graham CE, Mauldin DM. Morton's interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int 1995; 16 (12) 760-763
• 77 Nery C, Coughlin MJ, Baumfeld D, Mann TS, Yamada AF, Fernandes EA. MRI evaluation of the MTP plantar plates compared with arthroscopic findings: a prospective study. Foot Ankle Int 2013; 34 (03) 315-322
• 78 Hsu RY, Barg A, Nickisch F. Lesser metatarsophalangeal joint instability: advancements in plantar plate reconstruction. Foot Ankle Clin 2018; 23 (01) 127-143
• 79 Umans RL, Umans BD, Umans H, Elsinger E. Predictive MRI correlates of lesser metatarsophalangeal joint plantar plate tear. Skeletal Radiol 2016; 45 (07) 969-975
• 80 Sung W, Weil Jr L, Weil Sr LS, Rolfes RJ. Diagnosis of plantar plate injury by magnetic resonance imaging with reference to intraoperative findings. J Foot Ankle Surg 2012; 51 (05) 570-574
• 81 Flint WW, Macias DM, Jastifer JR, Doty JF, Hirose CB, Coughlin MJ. Plantar plate repair for lesser metatarsophalangeal joint instability. Foot Ankle Int 2017; 38 (03) 234-242
• 82 McAlister JE, Prissel MA. Plantar plate instability. In: Hyer CF, Berlet GC, Philbin TM, Bull PE, Prissel MA. eds. Essential Foot and Ankle Surgical Techniques. Cham, Switzerland: Springer; 2019: 57-68
• 83 Elmajee M, Shen Z, A'Court J, Pillai A. A systematic review of plantar plate repair in the management of lesser metatarsophalangeal joint instability. J Foot Ankle Surg 2017; 56 (06) 1244-1248
• 84 Highlander P, VonHerbulis E, Gonzalez A, Britt J, Buchman J. Complications of the Weil osteotomy. Foot Ankle Spec 2011; 4 (03) 165-170
• 85 McCarthy CL, Thompson GV. Ultrasound findings of plantar plate tears of the lesser metatarsophalangeal joints. Skeletal Radiol 2021; 50 (08) 1513-1525
• 86 Linklater JM, Fessa CK. Imaging findings in arthrofibrosis of the ankle and foot. Semin Musculoskelet Radiol 2012; 16 (03) 185-191