Return to Sport and Radiographic Postoperative Outcomes After Grade 3 Turf Toe Surgical Repair

Turf toe is a plantar plate injury of the first metatarsophalangeal joint that commonly occurs in athletes participating in outdoor cutting sports. However, there is a lack of evidence-based consensus on treatment guidelines and surgical outcomes in the current literature.

The purpose of this study was to report on postoperative clinical outcomes and return to sport for athletic patients treated for both acute and chronic grade 3 turf toe injuries at the authors' institution. It was hypothesized that patients would have significant improvement in pre- to postoperative clinical outcomes and quickly return to sport after surgical repair.

Case series; Level of evidence, 4.

The records of patients who received plantar plate repair at the first metatarsophalangeal joint between February 2016 to July 2022 by 3 fellowship-trained foot and ankle orthopaedic surgeons were reviewed. Inclusion criteria included athletes of at least high school-level competition who underwent plantar plate repair for a primary diagnosis of turf toe injury. Excluded were patients with histories of ipsilateral forefoot surgeries, rheumatoid arthritis, or gout. In total, 28 patients were identified and screened for inclusion. Patient-reported outcomes via Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected preoperatively and at least 1 year postoperatively for all patients. Return-to-sport data were collected via telephone call. Bilateral preoperative and postoperative radiographs were analyzed to measure preoperative and postoperative sesamoid diastasis.

The improvement in pre- to postoperative PROMIS scores was found to be significant for Physical Function, Pain Interference, Pain Intensity, and Global Physical Health. A total of 21 return-to-sport surveys were completed from the patient cohort. Nineteen of 21 (90.5%) of patients were able to return to preinjury levels of physical competition. The mean time to return to sport was 20.4 weeks (range, 12-32 weeks). Both medial and lateral sesamoids demonstrated a significant pre- to postoperative improvement in sesamoid diastasis. No difference in outcomes was observed between acute and chronic injuries.

Patients who received plantar plate repair for a grade 3 turf toe injury demonstrated significant improvement in patient-reported outcomes and were able to quickly return to sport at a high rate.