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Early motion is encouraged with grade II and III injuries
4%
11/301
Nonoperative management consists of rest, ice, and immobilization with the toe splinted in 5 to 10° of dorsiflexion
24%
71/301
Less than 5% of injuries will require surgical intervention
43%
128/301
Surgical repair is the best initial treatment for complete tears of the plantar plate
28%
85/301
Sesamoid excision is the best initial treatment for complete tears of the plantar plate
1%
4/301
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Studies have shown that only 1.7% of turf toe injuries ultimately require operative intervention.Turf toe is a hyperdorsiflexion injury to the plantar plate and sesamoid complex of the big toe metatarsophalangeal joint that most commonly occurs in contact athletic sports. Diagnosis is made clinically with the inability to hyperextend the hallux MTP joint without significant pain, and the inability to push off with the big toe. A vertical Lachman test will show greater laxity compared to the contralateral side. Treatment consists of rest, NSAIDs, taping, and the use of a stiff-sole shoe or walking boot in the majority of cases. Surgical repair is indicated for patients with progressive and persistent symptoms who fail nonoperative management. Smith et al. reviewed hyperextension injuries to the first metatarsophalangeal joint. They reported that complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. They concluded that operatively treated grade 3 turf toe injuries that were treated surgically had good clinical outcomes.George et al. reviewed turf toe. They reported a significantly higher incidence of turf toe injuries during games, a greater susceptibility among running backs and quarterbacks, and a significant contribution of playing surface to the risk of injury. They concluded that turf toe injuries may be less common than previously reported in elite football players.Incorrect Answers:Answers 1&2: Initial management is rest, ice, nonsteroidal anti-inflammatory drugs, and immobilization in plantarflexion.Answer 4: Indications for early surgical intervention include large capsular avulsions, diastasis of a bipartite sesamoid, diastasis of a sesamoid fracture, retraction of the sesamoids, a traumatic hallux valgus deformity, vertical instability, loose bodies, chondral injuries, and failed nonsurgical management.Answer 5: Excision of the sesamoids may be considered with failed nonoperative management and depends on fragmentation size.
2.0
(3)
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