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Turf toe

Introduction

Despite its rather benign namesake, turf toe is a incapacitating injury that plagues many athletes who participate in running/cutting sports on hard surfaces. The injury involves a sprain of the metatarsalphalangeal joint (typically the first MTP). American Football is the most notable sport to have many of its players suffer from turf toe. As artificial playing surfaces became more popular in the 1970s, the incidence of turf toe injuries saw a large incline. This is due to the less "giving" nature of artificial turf as opposed to natural grass. Notable athletes who have suffered turf toe injuries include Deion Sanders, Jeremy Shockey, and LaDainian Tomlinson.

Anatomy

  • Metatarsalphalangeal joints connect the metatarsal bones of the foot with the proximal phlanges of the toes
  • The bones at the MTP joint are connected by the plantar and two collateral liagments
  • The following tendons attach near this joint: abductor hallucis, adductor hallucis, medial and lateral heads of hallucis brevis

Pathogenesis

  • The typical injury occurs when the foot is dorsiflexed with the heel raised off the ground and the toes planted (equinus position)
  • While in this position, an external force causes the foot to go into greater dorsiflexion which results in strain across the MTP joint (hyperextension)
  • Essentially, the toes are gripped into the playing surface (due to the cleat) while the increased dorsiflexion occurs
  • Tears can occur in the joint capsule (most notable at the metatarsal neck)

Natural History

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Patient History and Physical Findings

  • Patients will note a huge defect in their ability to accelerate, jump, and make agility moves; this is because extension of the toes while dorsiflexed (i.e. "pushing off") is necessary for these maneuvers

Imaging and other Diagnostic Studies

  • Plain radiographs are most helpful
  • MRI is not currently recommended

Differential Diagnosis

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Treatment

  • Include: Rest is the biggest component for healing; patients must try to relieve any pressure on the toes including walking in some instances
    Medical therapy: Anti-inflammatory medication (NSAIDs)
    Nonoperative treatment: Rest, icing, rigid-soled shoe (to prevent toe extension and flexion)
    Operative treatment - include links to pages with detailed surgical techniques
    Indications and contraindications

Pearls and Pitfalls

  • It is difficult to impossible to tape or brace the MTP due to its unique location and ROM

Postoperative Care

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Outcome

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Complications

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Selected References

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