Blake Griffin, Los Angeles Clippers’ star power forward, did not return to play the second half in last Friday’s first round playoff game against the Utah Jazz. The 28 year-old reportedly suffered an injury to the plantar plate of his right big toe. It is a big loss for the Clippers, who now trail the Jazz 3-2 in their best of seven series. Griffin, who will not return to action this post season, was evaluated Tuesday by a foot and ankle specialist. Accounts say that he will seek several other opinions prior to undergoing surgery.

What is the plantar plate?

The plantar plate is a structure that functions as an especially strong ligament. It is thicker and stronger than most ligaments, and rests on the plantar (bottom) surface of the joints formed by the long bones of the forefoot (the metatarsals) and their corresponding proximal phalanges – the lowermost bones at the base of the toes. These are referred to as the MTP joints. The plantar plate connects the bones that form these joints with an attachment to the metatarsal that is less firm than that to the phalanx. It arises from the plantar aponeurosis and plantar capsule of the MTP joints and serves as an attachment for a number of ligaments and tendons in the area.

Because the bony surfaces at the first MTP joint are quite shallow, it relies on the capsule, ligaments, and flexor tendons for its stability. The medial and lateral collateral ligaments are those that check against lateral and medial forces, providing valgus and varus stability,

An important stabilizing function of the plantar plate is to offer a restraint that checks against subluxation or dislocation of the joint – generally toward the top of the foot (dorsally). The plantar plate at the first toe, the hallux, which Griffin injured, is distinguished from those at the other toes because of the two small sesamoid bones that lie within the complex.

Though more passive in offering support while simply standing, structures of the foot that support our body weight are most critical during propulsion, and are stressed even further with the actions required in playing sports.

How is the plantar plate injured?

Pathology at the plantar plates of the second and third toes is diagnosed more often than that at the first toe. In these cases however, the diagnosis is generally of a more chronic and degenerative nature and is also referred to as metatarsalgia. It can result from abnormalities in the alignment at the foot (i.e. from a bunion), biomechanical issues or, as some literature notes, repeated steroid injections.

In athletics, it is the plantar plate at the big toe that is injured most often. This traumatic injury, which is likely that suffered by Blake Griffin, is also known as turf toe. The hallmark of this diagnosis is a tear of the joint capsule from the metatarsal head. This allows the proximal phalanx of the toe to drift upward, subluxing or dislocating the joint.

Injury to the articular cartilage and adjacent tendons can also be involved with traumatic plantar plate disruption at the first MTP joint.

Turf toe is most commonly caused by a hyperdorsiflexion trauma to the plantar plate at the big toe. Hyperdorsiflexion is when the toe is forced upwards/backwards (from the MTP joint) beyond its normal range of extension. This is particularly prevalent in football due either to the nature of certain tackles or from the grip that flexible cleated shoes have on artificial turf.

The injury also less commonly results from hyperflexion of the MTP or from a valgus force.

Diagnosis and Treatment

Blake Griffin undoubtedly underwent several different imaging studies in order to identify the type of plantar plate injury he has and whether it is accompanied by fracture. Detail on the types of imaging generally used, and the advantages of each option, can be found here.

As with many orthopedic injuries, dislocations of the first MTP are classified as either type one, two, or three. Unlike most injuries, where type three requires the most aggressive surgical care, that is not the case with MTP dislocations. Type one MTP dislocations are the only one of the three categories that typically requires surgical intervention. Features of type one MTP dislocations are noted by Wheeless’ Textbook of Orthopaedics to be as follows:

  • Plantar plate ruptures at its proximal attachment to metatarsal neck & dislocates with attached sesamoids riding over metatarsal head
  • Plantar plate-sesamoid complex follows the proximal phalanx
  • Metatarsal head can buttonhole into the plantar capsule which prevents closed reduction
  • Disruption of volar plate – sesamoid complex
  • No sesamoid fracture
  • No widening of inter-sesamoid space
  • Reduction is blocked by the interposed volar plate;

Treatment for these entails an open reduction via a dorsal approach.

Following types two and three traumatic subluxation or dislocation of the MTP joint, alignment is often restored with a closed reduction (repositioning manually and without surgical intervention). This is followed by a period of reduced activity and wearing a brace to restrict mobility into dorsiflexion once activities are resumed.


About the author

Abby serves as the Injury Expert for CBS New York where, since 2010, her Injury Breakdown Blog examines injuries in professional sports. She also blogs on health & fitness as well as sports injuries for Huffington Post, and Recovery Physical Therapy.com, where her blog earned a top ten mention for physical therapy blogs in 2012 @ WorldWideLearn.com. In a ranking of the Top 30 Healthcare Blogs for 2012, Top Masters in Healthcare also rated Abby’s blog in the top three in Physical Therapy! Abby is the founder of Fit-Screen and she welcomes your comments and questions!

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