During Game #3 of Round #1 in the post-season NBA playoffs, Blake Griffin injured his big toe while doing a layup. It has been noted that he suffered a plantar plate injury and will be out for the rest of the season (5). His treatment has not been determined, or made public, yet, but it looks like the forward may be out for several weeks.
What Is the Plantar Plate?
The plantar plate is a ligament (soft tissue structure) that connects the metatarsal head to the proximal phalanx (toe bone). It is part of the big toe joint capsular ligamentous complex that must withstand up to eight times one’s body weight with high-impact activities, such as a running jump (3).
How Does the Plantar Plate Get Injured?
When the toe is hyperextended, the plantar plate is at risk for injury, which may include straining, tearing, or rupturing of the ligament. You can think of the injury as being a severe case of turf toe. In the case of Griffin, the plantar plate was likely injured as he went up for the layup and his foot was in a plantar-flexed position while the big toe hyperextended.
How to Diagnose a Plantar Plate Injury?
Diagnosing a plantar plate injury is multifaceted and should include a very detailed clinical exam, as well as imaging studies.
Clinical exam – Pain and/or bruising is likely to be around the big toe joine. If the plantar plate is completely ruptured, the toe may have an obvious deformity (or be dislocated). Active and passive range of motion around the joint is important to check, in addition to evaluating the strength of the two tendons running under the big toe (flexor hallucis longus and flexor hallucis brevis). The patient may have weakness bending their toe down or may have pain with resisting the same motion (2). The Lachman test can also be done, which tests for stability of the joint (2,3).
Imaging – X-rays are usually the first thing ordered to rule out a fracture. It is good to take bilateral foot films to be able to compare the feet to one another, especially when looking at the position of the sesamoids (two small bones under the 1st metatarsal head), as they can retract with plantar plate injuries (see picture at right). A stress x-ray (or fluoroscopy) can also be used to check sesamoid migration (2,3).
Since the plantar plate is soft tissue, though, radiographs will not show the actual plantar plate; therefore, an MRI can then be ordered to visualize the plantar plate, as well as to evaluate the extent of the injury.
Many things need to be taken into consideration when treating plantar plate injuries, including the timing of the injury, the severity (based on clinical exam and imaging modalities), as well as the age and activity level of the patient.
Conservative care – Conservative treatment is typically done for less severe cases. The typical RICE protocol can be initiated to help with pain and swelling (4). If the plantar plate is weakened from the injury, the toe may be taped down to allow for ligament reapproximation and to inhibit the toe from elevating with ambulation. In more severe cases, immobilization in a walking boot or cast may be necessary. Return to activity will be largely determined by the grade, or extent, of the injury (3,4).
Surgical treatment – In specific circumstances, surgery may be warranted in order to restore normal anatomy and improve function of the big toe (4). The plantar plate and ligamentous complex can be directly repaired surgically with the use of suture. If there is noted to be further injury or damage around the area, that can also be corrected for at that time.
Oftentimes, when it comes to elite athletes, surgical treatment is preferred because, by putting internal hardware in the foot, or in this case, reinforcing the ligament with suture, it typically allows them to bear weight and rehab sooner. If not treated appropriately, though, chronic deformity, pain, and push-off weakness may result (1). Despite what the treatment decision is with Griffin, it could be 3 months, or longer, before he is allowed to return to activities.
Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Should you have questions or concerns about your health, consult your own healthcare professional.
1. Anderson, R. B. (2002). Turf toe injuries of the hallux metatarsophalangeal joint. Techniques in Foot & Ankle Surgery, 1(2), 102-111.
2. Drakos, M. C., Fiore, R., Murphy, C., & DiGiovanni, C. W. (2015). Plantar-Plate Disruptions:“The Severe Turf-Toe Injury.” Three Cases in Contact Athletes. Journal of athletic training, 50(5), 553-560.
3. McCormick, J. J., & Anderson, R. B. (2009). The great toe: failed turf toe, chronic turf toe, and complicated sesamoid injuries. Foot and ankle clinics, 14(2), 135-150.
4. McCormick, J. J., & Anderson, R. B. (2010). Turf toe: anatomy, diagnosis, and treatment. Sports Health, 2(6), 487-494.
5. Turner, B. ( 2017, Apr 25). Clippers' Blake Griffin sees foot specialist for right toe injury. Retrieved from http://www.latimes.com/sports/clippers/la-sp-clippers-report-20170425-story.html.