Sports Medicine Physicians
For a complete listing of all of our physicians click here.
We serve as team physicians for the Washington Redskins, George Mason University Patriots and nineteen area high schools. Commonwealth Orthopaedics is equipped to help amateur, student and professional athletes alike. Whether it is an injury or just normal wear and tear, we work closely with our patients to develop individualized treatment plans to help them get back in the game.
- Aguiar, George, MD
- Annunziata, Christopher C., MD
- Avery, Anthony L., MD
- Avery, Gordon L., MD
- Dombrowski, Robert M., MD
- Hartley, Mark C., MD
- Kittredge, IV, Ben W., MD
- Klein, Thomas J., MD
- Lane, H. Edward III, MD
- Lawhorn, Keith, MD
- Lutta, Kevin C., MD
- Madden, Mark P. MD
- Martinelli, Thomas A., MD
- Novak, David J., MD
- Parker, D. Andrew, MD
- Pettrone, Frank A., MD
- Sumida, Kevin D., MD
- Thompson, Daniel E., MD
- Vitek, Jr., Brantley P., MD
- Weingold, Daniel E., MD
- You, Young J., MD
- Zimmer, Bruce S., MD
Plantar Plate Tear
Plantar Plate Tear is a sprain of the main joint of the big toe. It happens when the toe is forcibly bent up into hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground.
Sprains of the big toe joint became especially prevalent in American football players after artificial turf became more common on playing fields - hence the term "turf toe." Artificial turf is a harder surface than grass and does not have much "give" when forces are placed on it.
Although often associated with football, turf toe occurs in a wide range of sports and activities.
The typical position of the foot when a turf toe injury occurs.
The big toe is made up of two joints. The largest of the two is the metatarsophalangeal joint (MTP), where the first long bone of the foot (metatarsal) meets the first bone of the toe (phalanx). In turf toe, the MTP joint is injured.
The MTP joint is the large joint closest to the base of the big toe.
The joint is surrounded by important structures that hold it in place and prevent it from dislocating. Together these structures are referred to as the "plantar complex."
- Plantar plate. This thick, fibrous tissue under the MTP joint prevents the big toe from bending too far (dorsiflexion).
- Collateral ligaments. Located on each side of the big toe, collateral ligaments connect the phalanx bone to the metatarsal and prevent the toe from going too far side-to-side.
- Flexor hallucis brevis. This tendon runs under the first metatarsal bone and attaches to the phalanx. It provides strength and stability to the big toe during push-off motions.
- Sesamoids. These two small bones are enveloped in the flexor hallucis tendon, and help it to move more easily. In addition, the sesamoids provide stability to the MTP joint by helping to bear weight placed on the forefoot.
Several structures work together to protect and stabilize the MTP joint.
The term "turf toe" refers to an injury of any soft tissue structure in the plantar complex, such as the plantar plate or a collateral ligament. These injuries can vary in severity — from stretching of the soft tissue to partial tearing, and even total dislocation of the MTP joint.
To help them plan treatment for turf toe, doctors grade the injuries from 1 to 3 - mild to severe.
- Grade 1. The plantar complex has been stretched causing pin-point tenderness and slight swelling.
- Grade 2. A partial tearing of the plantar complex causes more widespread tenderness, moderate swelling, and bruising. Movement of the toe is limited and painful.
- Grade 3. The plantar complex is completely torn causing severe tenderness, severe swelling, and bruising. It is difficult and painful to move the big toe.
Turf toe can occur in any sport or activity when the forefoot is fixed on the ground, the heel is raised, and a force pushes the big toe into hyperextension.
These injuries most often occur among American football players on artificial grass. Artificial surfaces tend to be harder and less shock absorbent. In addition, the athletic shoes designed for artificial surfaces are softer and more flexible, providing the athlete with more agility, but much less stability in the forefoot.
The force of a football tackle can hyperextend the MTP joint and cause turf toe.
Thinkstock © 2012
First Aid Treatment
The RICE protocol is effective for most sports-related injuries when they first occur. RICE stands for Rest, Ice, Compression, and Elevation.
- Rest. Take a break from the activity that caused the injury and avoid walking or putting weight on your foot.
- Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
- Compression. To help prevent additional swelling, wear an elastic compression bandage.
- Elevation. To reduce swelling, recline when you rest, and put your leg up higher than your heart.
In addition, over-the-counter anti-inflammatory medications, such as ibuprofen, can help provide symptom relief.
For more information on how to treat Plantar Plate Tear, please visit www.aaos.com