Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, CO, USA.
Foot Ankle Int. 2013 Mar;34(3):403-8. doi: 10.1177/1071100712464953. Epub 2013 Jan 14.
The term turf toe has been generally applied to athletic dorsiflexion injuries of the hallux metatarsophalangeal (MTP) joint. Variations in injury patterns coupled with the complexity of the MTP joint makes the diagnosis of more severe injuries challenging and may lead to a failure in recognition of an unstable joint and a subsequently prolonged recovery. Although the proximal migration of one or both sesamoids has been previously identified with a plantar plate disruption, the current study proposes a quantitative grading system based on dorsiflexion stress radiographs, providing a predictable and reproducible test for evaluating the extent of injury to the first MTP joint.
Twenty-four nonpaired fresh-frozen foot/ankle specimens with no history or physical evidence of prior injury were used in this study. The specimens were randomly assigned into 4 cutting groups, and the 4 main distal ligaments of the plantar plate were identified and sectioned. Lateral dorsiflexion fluoroscopic stress images were obtained in the intact state and with each subsequent cut. With each image, measurements from the distal margin of the sesamoids to the most proximal margin of the proximal phalanx were taken. Images were obtained at 45 degrees with both a fibrous loop wrapped around the interphalangeal joint and applying 15 N and also with a manual dorsiflexion stress. Statistical testing performed was a repeated-measures analysis of variance with Tukey post hoc to compare measurements between each group to determine if movement of the sesamoid bones relative to the phalanx quantitatively increased with each structure that was cut.
Our results demonstrate a relationship between the number of ligaments injured in the turf toe simulation and an increase in sesamoid phalangeal distance. We found that an increase of 3 mm in the distance from the sesamoids to the proximal phalanx was significant and predictive of a severe injury to the plantar plate.
Injuries producing differences of 3 mm or greater from the intact state have a high likelihood of having sustained injury to at least 3 of the 4 ligaments of the plantar plate complex. This study is the first to establish a quantitative grading scale for evaluating turf toe injuries radiographically based on changes in movement of the sesamoids relative to the intact state.
In assessing a turf toe injury, historically the evaluation has been qualitative, but our study provides quantifiable data for evaluation of the severity of plantar plate injuries, which may provide guidance to physicians for treatment decisions.
“趾球部撞击综合征”一词通常用于描述足背屈性的第一跖趾关节（MTP）损伤。由于损伤模式的变化以及 MTP 关节的复杂性，严重损伤的诊断具有挑战性，可能导致对不稳定关节的认识不足，从而导致康复时间延长。尽管先前已经确定了一个或两个籽骨的近端迁移与跖板破裂有关，但本研究提出了一种基于背屈应力射线照相的定量分级系统，为评估第一 MTP 关节损伤的程度提供了一种可预测和可重复的测试方法。
本研究使用 24 个无配对的新鲜冷冻足/踝标本，无既往损伤史或体格检查证据。将标本随机分为 4 个切割组，并识别和切断跖板的 4 个主要远端韧带。在完整状态和随后的每次切割时获得外侧背屈荧光透视应力图像。对于每个图像，从籽骨的远端边缘到近节骨的最近端边缘进行测量。图像在 45 度角获得，纤维环缠绕在关节间并施加 15N 的力，同时进行手动背屈应力。进行的统计测试是重复测量方差分析，Tukey 事后检验用于比较每组之间的测量值，以确定籽骨相对于指骨的相对运动是否随每个被切割的结构而定量增加。
我们的结果表明，趾球部撞击综合征模拟中损伤的韧带数量与籽骨-指骨距离的增加之间存在关系。我们发现，籽骨与近节骨之间距离增加 3mm 具有显著意义，并可预测跖板严重损伤。
与完整状态相比，差异为 3mm 或更大的损伤很可能至少有 4 个跖板复合体的韧带之一受到损伤。本研究首次建立了一种基于籽骨相对于完整状态的运动变化，对趾球部撞击综合征损伤进行放射学评估的定量分级量表。
在评估趾球部撞击综合征损伤时，传统上评估是定性的，但我们的研究提供了可量化的数据来评估跖板损伤的严重程度，这可能为医生的治疗决策提供指导。
