SLR - April 2015 - Fraaz Sayeed
Reference: Faltus J, Mullenix K, Moorman CT 3rd, Beatty K, Easley ME. Case Series of First Metatarsophalangeal Joint Injuries in Division 1 College Athletes. Sports Health. 2014 Nov;6(6):519-26.Scientific Literature Review
Reviewed By: Fraaz Sayeed, DPM
Residency Program: Saint Vincent Hospital/WMC
Podiatric Relevance: Injuries to the first MPJ in athletic patient populations are important to podiatric surgeons due to the debilitating nature of the injury. Likewise, difficulty in accurately diagnosing turf toe/plantar plate injuries from other soft tissue or ligamentous injuries can be arduous. Recent literature has supported a combination of the Lachman test and radiographic imaging for first MPJ injuries with possible joint instability. Current guidelines and criteria for treatment including non-surgical and surgical options are limited to cases studies and literature reviews. This articles uses an accumulation of 5 case series involving Division 1 college male athletes with subsequent first MPJ injuries to compare intervention strategies and outcomes when managing injuries of this nature.
Methods: Research databases were used to find and review articles from 1970-2013 involving injuries to the first MPJ involving collegiate athlete populations. Furthermore, EMR’s were used in each specific case to acquire additional information on the patient in regards to imaging, surgical, and rehab reports/documentations.
Results: Treatment plans for each case were diverse and wide-ranging depending on if non-surgical or surgical outcomes were done. All case studies involved athletes playing American football. In two out of the five case studies a conservative treatment option was deemed best. In three cases, surgery was found to be necessary. The common theme in these cases studies all depended upon the patients’ physical exam, specifically the Lachman test, and the patients given circumstances as athletes pursuing possible professional careers. Positive Lachman tests usually concluded in a surgical outcome in respect to the case studies presented. The use of an MRI was also commonly performed for all patients in these specific case studies. The article discusses conservative treatment options in three phases from early onset of the injury until full recovery. Typically, conservative treatment options required six-10 weeks from beginning of the injury to end. These included non-surgical options such as RICE, taping, carbon graphite shanks, customized orthotics, and CAM boots. The case studies that pursued surgical outcomes usually required direct repair of the plantar plate as well as reinforcement to aspects of the sesamoid apparatus. This was all dependent upon MRI findings. Radiographs also proved useful in comparing contralateral images to determine baseline for proximal migration of the sesamoids. Nonetheless, the key aspect was that all athletes reviewed in these cases were able to return to their sports specific activities, respectively, on a patient specific treatment plan.
Conclusion: The most important aspect to gather from this study overviewing several cases for first MPJ injuries in athlete populations is a thorough evaluation is paramount. Appropriate clinical decision making in pursuing either non-surgical or surgical treatment options can also play a huge role in helping the patient return to their sports-specific activities. Likewise, a multi-disciplinary team approach is significant for the safety of the patient in their return to activity as well.