10/29/2012 11:24 am ET Updated Dec 29, 2012

Plantar Plate Tear: Redskins Pierre Garcon's Toe Injury

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Redskins wide receiver Peirre Garcon sustained a ligament injury of the second toe, and is reported to specifically have a plantar plate tear. This is no ordinary ligament injury as the the plantar plate is a thick ligament-like pad beneath the toe that stabilizes the toe.

Small simple acute tears can heal well without surgery, but chronic larger tears are more challenging and can require intervention. Garcon is reported to have a partial tear and hopes to avoid surgery.

As a reconstructive foot surgeon who has authored a surgical technique guide on plantar plate repairs, and performed research on the injury, I can tell you that plantar plate tears can be unpredictable in terms of recovery. Some patients heal without any problems and return to full activity whereas other patients can develop instability of the toe and chronic pain requiring surgery. With early diagnosis and proper treatment, in the absence of major instability of the toe, the recovery is favorable.

The average person who sustains this injury often goes undiagnosed for weeks or months and the ligament doesn't heal. The plantar plate is a difficult ligament to heal because it is thick, and the structure itself doesn't have the best blood supply. When these injuries become chronic, the toe can become unstable, painful, structurally deformed (develop a hammer toe), or in some cases dislocate altogether.

Surgery for plantar plate tears is best performed earlier than later, before structural changes occur. The surgery involves making an incision on the bottom of the foot and directly sewing the ligament together. In subacute cases, the ligament tear is often simple and the repair is straightforward. In chronic cases, the ligament becomes eroded and the repair can be complex requiring bone anchors and ligament augmentation.

One problem with plantar plate injuries is that the severity can be difficult to grade. Severe injuries that present with instability are easy to determine the need for surgery. More subtle injuries are challenging because MRI can show injury but it's not perfect. The best way to determine the integrity of the ligament is with a study called an arthrogram, where a needle is inserted into the joint and radiographic dye is injected into the area to see if any dye leaks out. An arthrogram will not indicate severity, only disruption. Severity is best determined clinically by seeing if the toe can be manually dislocated.

Because of Garcons elite athlete status he has a good chance of recovery without surgery because his diagnosis was made early. But then again, that decision ultimately depends on how severe his plantar plate tear is. One thing is for sure, if he has continued pain or develops instability then surgery will be needed sooner than later.

-- Dr. Blitz
New York City

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