FOOT PAIN: FOOTBALL

Abstract

1060 HISTORY---A nineteen year old football safety for a Division III football team injured his left great toe while playing. He jumped up to defend a pass and came down on the tip of his toe. He had immediate onset of mild pain in the toe but he continued to play. Over the next two days he continued to practice with no to little pain in the toe. However, he did notice some pain around the front of his ankle. He also noticed the inability to lift up his great toe. He had no previous injury to that ankle, foot or toe in the past. He did not have any parasthesias and was in good health otherwise. He presented to the training room four days after the injury. PHYSICAL EXAMINATION---He was in no distress and could walk normally with and without footwear. He had no swelling or ecchymosis in his ankle, foot or toe. His great toe was held in a plantar-flexed position a the interphalangeal joint. He had tenderness over the interphalangeal joint (IP) and the proximal aspect of the distal phalanx dorsally. He had no tenderness proximally and there were no palpable lumps or crepitus over the dorsum of the foot. He had normal flexion of the great toe at the metatarso-phalangeal joint but not a the interphalangeal joint. The defomity at the IP joint was painlessly correctable by passive extension of the distal phalanx. Passive flexion of the ankle relaxed the flexion deformity at the IP joint whereas extension(dorsiflexion) increased the deformity. He was neurologically intact otherwise. DIFFERENTIAL DIAGNOSIS Rupture extensor hallicus longus tendon Fracture or IP joint abnormality TEST AND RESULTS: Plain Radiographs: Volar angulation of the distal phalanx of the big toe with no fracture of subluxation. FINAL/WORKING DIAGNOSIS: Traumatic rupture of the extensor hallicus longus tendon. TREATMENT: Operative exploration: intrasubstance failure and elongation of the tendon at the IP joint level. Shortening and reattachment of the tendon to the distal phalanx using suture anchors. Placed in fracture walking boot with rigid toe plate for five weeks Gradual return to activities with no recurrence of the deformity