Clinical Consult

Has anyone heard of someone rupturing or avulsing the FHB? I have a patient who sustained an injury to his 1st MTP about 4 months ago.  He has excessive 1st MTP extension with pain and empty endfeel.  PROM at the joint is slightly restricted by muscular endfeel.  The EHL and EHB 5/5 with pain at the 1st MTP.  FHL 5/5. FHB 0/5.  No significant laxity was noted at the joint.  Other differential diagnosis may be rupture of plantar plate??

Thanks for any help!
Talia

Comments

[Robbie Hinkebein]

Talia,
I assume the extension that you describe above is for passive MTP ext. How are you differentiating to keep the FHL out of the equation? If the FHL longus is 5/5 and the FHB is 0/5 then you would expect to see hyperextension of the MTP joint and the IP joint flexes with MMT. If this is the case then you may very well have a FHB rupture. If not, I would tend to think a more probable cause would be plantar plate/plantar fascia rupture. Does the patient have pain of ant. med. calcaneal tubercle.
Robbie

[Julie]

Plantar plate ruptures always have a positive vertical shear test at the MTP with a PA force. I can send an article on this if you want it. I just had surgery for plantar plate tear and 2nd MTP instability.