602 - Treatment of a Toe A3 Pulley Tear in a Professional Athlete with PRP: A Case Report

A 28-year-old female professional golfer presented with a one-year history of intermittent right forefoot pain and difficulty flexing the second toe, worsening over three months and limiting her ability to golf. Conservative measures—including home exercises, activity modification, and toe spacers—were unsuccessful. Exam revealed tenderness over the plantar proximal interphalangeal joint with pain on toe flexion but no instability or deformity. X-rays were unremarkable. MRI confirmed a partial tear of the A3 pulley of the second toe with minimal tendon bowstringing. Given her status as a professional athlete and preference to avoid corticosteroids, she underwent an ultrasound-guided injection of leukocyte-rich platelet-rich plasma (PRP), prepared using the EmCyte system. Her foot was immobilized in a toe splint and stiff-soled shoe for two weeks, followed by a structured rehabilitation program emphasizing toe range of motion, flexor strengthening, and progressive weight-bearing. She experienced significant relief and returned to full competition by six weeks.

Discussions: While finger pulley injuries are well-characterized and have established treatment guidelines, annular pulley injuries of the toes remain exceedingly rare and underrecognized, with only a few cases reported in the literature. No prior case of an A3 pulley tear in the foot of an elite athlete has been described. While PRP has shown promise in enhancing tendon and ligament healing, its application for pulley injuries remains minimally reported. In this case, PRP may have contributed to an accelerated recovery relative to the prolonged course typically observed with conservative care alone. 

Conclusions: This case highlights a rare but clinically significant cause of forefoot pain in athletes and demonstrates the potential role of PRP in expediting healing of toe pulley injuries. Increased awareness of this diagnosis and consideration of biologic therapies may optimize outcomes and facilitate return to sport.