Challenge of the Week / Foot & Ankle / 02.25.2022

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?  
    • 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.

 

    • 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.

 

    • 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.

 

    • Cast immobilization for 2 months
    • Cast immobilization may result in excessive stiffness and limitation.

 

 

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