| A 43-year-old male accountant injures his great toe while playing softball. He reports a hyperextension injury. Radiographs show no fracture and no proximal shift of the sesamoids relative to the contralateral extremity. Magnetic resonance imaging is obtained and shows a partial tear of the plantar plate. His hindfoot alignment is neutral. Which of the following is the most appropriate treatment? |
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- Immobilization in a controlled ankle movement boot for several weeks and then progressive activities with toe taping A partial plantar plate tear can be successfully treated with a course of brief immobilization, with progressive return to activity while taping the toe.
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- Open operative repair of the plantar plate Open operative repair is not indicated for the partial tear sustained by this patient. It would be indicated for a full tear with sesamoid retraction.
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- Semi-rigid custom orthotics with a lateral forefoot post Custom orthotics might be offered after an initial period of immobilization in a boot. However, a lateral forefoot post would increase the load on the sesamoid. The more appropriate device would be an accommodative orthotic with a relief under the sesamoids.
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- Cast immobilization for 2 months Cast immobilization may result in excessive stiffness and limitation.