Plantar Plate Injury (Turf Toe)

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Anatomy

See Drakos et al for a brief review. The first MTPJ integrity is related primarily to the joint capsule, collateral capsular ligaments, and the flexor-tendon complexes coursing on either side. The soft tissues stabilise the joint allowing for approximately 50° of dorxiflexion and 30° of plantarflexion.

• Medial and lateral collateral capsular ligaments - provide valgus and varus stability.
• Medial flexor-tendon complex - comprised of the medial head of FHB and abductor hallucis, which envelops the medial sesamoid and attaches to the medial proximal phalanx.
• Lateral flexor-tendon complex - comprised of the lateral head of FHB and adductor hallucis, which envelops the lateral sesamoid and attaches to the lateral proximal phalanx.
• Sesamoids - fulcrums that increase the lever arm of the FHB tendons and increase the plantar strength of the first MTPJ.
• Flexor hallucis longus (FHL) - the tendon is in a separate sheath between the sesamoids and inserts on the distal phalanx.
• Plantar plate - fibrocartilaginous structure which is made up of the thickened plantar joint capsule, and medial and lateral flexor-tendon complexes. It courses from the first metatarsal head and attaches to the proximal phalanx.

Literature Review

Literature Review

Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf

Articles from all years: PubMed search, Google Scholar search.

TRIP Database: clinical publications about evidence-based medicine.

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