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The JBJS Quiz of the Month is a collection of 10 relevant questions from each orthopaedic subspecialty. The questions are drawn from JBJS Clinical Classroom, which houses over 4,500 questions and 3,100 learning resources. Take the Quiz to see how you score against your peers!

NOTE: This quiz does not earn users CME credits. The questions must be answered within Clinical Classroom to earn CME credits.

A 43-year-old male accountant injures his great toe while playing softball. He reports a hyperextension injury. Radiographs show no fracture and no proximal shift of the sesamoids relative to the contralateral extremity. Magnetic resonance imaging is obtained and shows a partial tear of the plantar plate. His hindfoot alignment is neutral. Which of the following is the most appropriate treatment?  
    • Immobilization in a controlled ankle movement boot for several weeks and then progressive activities with toe taping
      • A partial plantar plate tear can be successfully treated with a course of brief immobilization, with progressive return to activity while taping the toe.

 

    • Open operative repair of the plantar plate
      • Open operative repair is not indicated for the partial tear sustained by this patient. It would be indicated for a full tear with sesamoid retraction.

 

    • Semi-rigid custom orthotics with a lateral forefoot post
      • Custom orthotics might be offered after an initial period of immobilization in a boot. However, a lateral forefoot post would increase the load on the sesamoid. The more appropriate device would be an accommodative orthotic with a relief under the sesamoids.

 

    • Cast immobilization for 2 months
      • Cast immobilization may result in excessive stiffness and limitation.

 

 

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