Wk 5, Case 5 - Review

Patient History
30-year-old man with pain and swelling of the right great toe related to a football injury one day prior.

Findings
LATERAL:
Ruptured proximal lateral/fibular sesamoid phalangeal ligament and plantar plate with proximally retracted and displaced lateral/fibular sesamoid.
Low-grade edema compatible with low-grade strain within the distal lateral head of the flexor hallucis brevis and oblique and transverse heads of abductor hallucis muscles/myotendinous junctions adjacent to the fibular sesamoid.
Interstitial partial thickness tear of the lateral/fibular collateral ligament.

MEDIAL:
Attenuated proximal medial/tibial sesamoid phalangeal ligament and plantar plate with detachment/high-grade full-thickness tear. Proximally retracted/displaced medial/tibial sesamoid. Distal portion of the sesamoid phalangeal ligament markedly thickened/swollen.
Detached attachment of the abductor hallucis from the medial sesamoid. Separation 3mm.
Sprained and frayed appearance of the flexor hallucis brevis attachment to the medial/tibial sesamoid.
Partial-thickness incomplete undersurface tear of the dorsal aspect of the medial collateral ligament. No macrofiber retraction. Bulk of the ligament intact.

CENTRAL:
Swollen but intact intersesamoid ligament.
Central plate ruptured.
No dominant or penetrating osteochondral erosions or bodies.
Extensor mechanism near normal with minimal dorsal swelling.
Mild interstitial tendinosis of the flexor hallucis longus compatible with interstitial microtrauma just distal to the sesamoids. However, a partial thickness tear without rupture of the flexor hallucis longus at the interphalangeal joint of the 1st digit lies just atop of a solitary distal phalanx sesamoid.

OTHER:
Microtrabecular injury or fracture of the 2nd metatarsal head and microtrabecular bone injury at the base of the proximal phalanx P2.

Impressions
1. Grade 3 turf toe with complete plantar plate rupture from the lateral sesamoid rim to the medial sesamoid rim.
2. Moderate depth and likely silent tear of the flexor hallucis longus muscle just plantar to the interphalangeal joint of the 1st digit.