title: Case series of first metatarsophalangeal joint injuries in division 1 college athletes.
abstract: BACKGROUND
  Injuries of the first metatarsophalangeal (hallux MP) joint can be debilitating in the athletic population. Turf toe and plantar plate injuries are typically diagnosed similarly. However, variance in injury mechanism as well as compromised integrity of soft tissue and ligamentous structures make it difficult to accurately diagnose specific hallux MP injuries. Recent literature has supported the use of both radiographic imaging and the Lachman test as reliable indicators of joint instability in the presence of hallux MP injuries. To date, research supporting specific rehabilitation interventions and return-to-play decision making for hallux MP injuries has been limited to case studies and suggested guidelines from literature reviews. There is limited evidence suggesting specific criteria for surgical and nonsurgical decision making in conjunction with rehabilitation progressions to return an athlete to sport when managing hallux MP injuries.
  
  
  METHODS
  A literature search was performed using Medline, PubMed, and Google Scholar to find and review articles from 1970 to 2013 that addressed the basic anatomy of the plantar plate, injuries to this anatomical structure, and the evaluation, diagnosis, surgical and nonsurgical management, and rehabilitation of these injuries, specifically in the athletic population. Medical information for each case was gathered from electronic medical records from the individual athletes cited in this case series, which included imaging reports, rehabilitation documentation, and both evaluation and surgical reports. No statistical analysis was used.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Level 4.
  
  
  RESULTS
  Treatment plans for each case varied depending on surgical and nonsurgical intervention and rehabilitation outcomes. However, each athlete was able to return to sports-specific activities.
  
  
  CONCLUSIONS
  Successful outcomes for hallux MP injuries are contingent on thorough evaluation, appropriate clinical decision making with regard to surgical versus nonsurgical treatment planning, and a multidisciplinary team approach for ensuring a safe return to sport.
  C.
authors.affiliation: Howard Head Sports Medicine, Avon, Colorado.
authors.forename: John
authors.initials: J
authors.lastname: Faltus
authors.affiliation: Duke Sports Medicine, Department of Physical and Occupational Therapy, Duke Athletics, Durham, North Carolina.
authors.forename: Kerry
authors.initials: K
authors.lastname: Mullenix
authors.affiliation: Sports Medicine Section, Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Claude T
authors.initials: CT
authors.lastname: Moorman
authors.affiliation: Duke Sports Medicine, Department of Physical and Occupational Therapy, Duke Athletics, Durham, North Carolina.
authors.forename: Kyle
authors.initials: K
authors.lastname: Beatty
authors.affiliation: Sports Medicine Section, Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Easley
keywords: plantar plate; rehabilitation; turf toe