Friday, July 25, 2008

Soccer Players and the Plantar Plate

"I spent all my money on booze, girls and fast cars. The rest I just squandered."—George Best, English soccer star

A talented winger, George Best was renown for his extravagant lifestyle and soccer majesty. Here is a video of one of his goals, demonstrating his sheer athletic brilliance:

Football players, whether they are soccer or American football players, are prone to injuries of the foot and ankle. The hallux (great toe) can be a source of great pain, with injuries of the first metatarsophalangeal joint particularly common.

The term "turf toe" is used to describe various injuries of the 1st MTP joint, but classically refers to a hyperdorsiflexion injury of this joint. Other mechanisms of turf toe injury include valgus and varus injuries, as well as hyperflexion-related damage (Ohlson, B; emedicine). Structures that can be injured include the plantar plate, joint capsule, sesamoids, and adductor hallucis tendon.

Professional soccer player, who felt a "pop" and subsequent pain in the first MTP joint:

There is a tear of the plantar plate (red arrow), with fluid at the expected location of the plantar plate.

For comparison, here is an image from a normal patient, showing an intact plantar plate (green arrow). Also note the normal dorsal capsular recess (yellow arrow):

The plantar plate of the hallux arises primarily from the sesamoids and inserts on the plantar aspect of the base of the proximal phalanx.

The plantar plate supports the undersurface of the metatarsal head and resists hyperextension of the MTP joint. Injuries of the plantar plate can be extremely painful and debilitating, but these injuries usually respond to conservative treatment. When conservative management fails, surgery can be performed, and the avulsed plantar place can be reattached.
High-resolution MRI scans of the metatarsophalangeal joint can yield valuable information about the joint and surrounding soft tissue structures, particularly in high-performance athletes.

Vic David MD

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