Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 7 , ISSUE 2 ( July-December, 2020 ) > List of Articles

Mini Symposium: Forefoot Disorders

Forefoot Injuries in Sports

Sean HS Lai, Camelia QY Tang, Gowreeson Thevendran

Keywords : Foot, Foot ankle surgery, Foot injury, Metatarsal, Sesamoid, Sports

Citation Information : Lai SH, Tang CQ, Thevendran G. Forefoot Injuries in Sports. J Foot Ankle Surg Asia-Pacific 2020; 7 (2):50-56.

DOI: 10.5005/jp-journals-10040-1124

License: CC BY-NC 4.0

Published Online: 01-10-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Forefoot injuries are common injuries in high-impact sports. The forefoot experiences a large amount of stress during the late stance phase of the gait cycle. Repetitive load applied to the forefoot without adequate rest can lead to tissue breakdown, resulting in injury. Forefoot sporting injuries can deteriorate gait function, sporting performance, and quality of life. In this article, we review the typical presentation, approach, and treatment modalities of the commonest forefoot sporting injuries. These include metatarsal stress fractures, second metatarsophalangeal joint (MTPJ) instability, turf toe injury, sesamoid pathologies, as well as hallux valgus and rigidus. Metatarsal stress fractures are frequent overuse injuries. They can be managed conservatively with activity modification and protected weight-bearing or surgically with open internal fixation. Second MTPJ instability typically involves disruption of the second MTPJ ligamentous joint capsule. Management of this condition includes customized orthotics, physiotherapy, hydrocortisone and lignocaine (H&L) injections, osseous procedures for phalangeal alignment, and plantar plate repairs. Turf toe injury refers to a hyperextension injury of the plantar capsuloligamentous structure of the hallux MTPJ. Plantar plate repairs are typically indicated in grade III injuries or when conservative treatment has failed. Sesamoid injuries include stress fractures, infections, degenerative disease, and osteochondral lesions. Customized orthotics limiting flexion across MTPJ while providing sesamoid stress relief is helpful, while surgical treatment involves fixation with possible bone grafting or partial sometimes complete sesamoidectomy. While hallux valgus and rigidus are not specific to sportsmen, treatment should take into account the patient\'s athletic demand. These conditions are typically treated surgically with realignment osteotomies if refractory to conservative treatments such as foot orthoses and physiotherapy.

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