Management of Forefoot Injuries in the Athlete

AP radiograph illustrating callus formation after healing of a third metatarsal stress fracture.

Illustration of bone cuts during distal chevron osteotomy. (A) After exposure, saw cuts are made forming a distal-based chevron cut. (B) The distal fragment is manipulated to slide laterally approximately 6-8 mm.

Image illustrating plantar capsulotomy, releasing plantar tissues to allow increased dorsiflexion range-of-motion.

The Mo-Akin procedure. (A) Dorso-medial starting point. (B) The saw cut is aimed slightly proximal and plantar. (C) After a thin wedge is removed, the osteotomy is reduced manually (D) Fixation is with a compression screw.

Screw fixation of a Weil osteotomy.

(A) Radiographic images of sesamoid retraction (L) compared with normal sesamoid position (R). (B) Spectral Presaturation Inversion Recovery sagittal MRI of the great toe. Arrow demonstrates rupture of the capsular ligamentous complex just distal to the medial sesamoid bone.

(A) Medial exposure with arrow identifying the medial plantar nerve. (B) Lateral exposure with sutures in place. (C) Medial exposure with sutures in place. Arrow points to abductor hallucis tendon which was avulsed in this patient's injury. (D) Medial view with sutures tied (3 knots visible).

Imaging studies for a sesamoid fracture. (A) Plain radiograph—sesamoid axial view. (B) T1 weighted axial MRI. (C) Bone scan demonstrating uptake in the fibular sesamoid.

Medial exposure for tibial sesamoidectomy. Arrow points to excised tibial sesamoid.

Lateral exposure for fibular sesamoidectomy. Vessel loop contains plantar lateral digital nerve.