Turf toe

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Search Strategy

To find relevant information about Turf Toe injury was used Pudmed as database.
Keywords: Turf toe- hallux- first metatarsophalangeal joint AND injury- sports/athletic injuries AND foot- turf toe AND treatment- first metatarsophalangeal joint AND sprain- rehabilitation AND turf toe- traumatic lesions AND great toe- effect AND turf toe- hyperextension AND metatarsophalangeal joint- disorders MTP joint.

Definition/Description

Turf toe is an injury of the first metatarsophalangeal(MTP) articulation, due to  hyperextension of the big toe, which leads to damage of the plantar capsuloligamentous complex. It may cause tearing or complete disruption of these structures.

Clinically Relevant Anatomy

The slightly concave shape of the proximal phalanx with which the first metatarsal articulates creates little joint stability. The plantar capsule is thicker on the proximal phalanx and finishes in a thinner part on the metatarsal head. It supports the under surface of the metatarsal head and resists hyperextension of the metatarsophalangeal joint.(8) Additionally to the plantar capsule and the collateral ligaments, the MTP joint is dynamically  stabilized by the flexor hallucis brevis (FHB)(the hallucal sesamoids embedded in the FHB tendons), the adductor hallucis and the abductor hallucis tendons. (1)

Epidemiology /Etiology

In 1976 turf toe was for the first time described by Bowers and Martin, they studied the soccer players at the University of West Virginia and ascertained that during one season there where an average of 5,4 turf toe injuries.(1,2)
Further studies showed that the injury was much more frequently by soccer played on artificial turf surfaces.

It is caused by an overload on the hallux MTP joint in hyper-dorsiflexion position as happens when one player falls on another players’ heel.
Too strong adhesion at the surface so that the shoe sticks, while the bodyweight moves forwards when the player tries to stop quickly may cause an acute turf toe. A chronical condition is mostly caused by frequent running and jumping with extremely flexible shoes. (1, 3, 5, 9)
The injury results very often not due only to hyperextension but also to a degree of valgus stress.

Characteristics/Clinical Presentation

It is characterized by pain as a first symptom, localized swelling, ecchymosis and stiffness of the joint.
With an appropriate evaluation we can divide the disease in three grades, each with his proper symptoms and treatments.

• Grade I injury symptoms are: local swelling, plantar structures attenuation or stretching, minimal ecchymosis.
• Grade II injury symptoms are: moderate swelling, partial tear of plantar structures and restricted motion as result of pain.
• Grade III injury symptoms are: indicative swelling and ecchymosis, total disruption of the plantar structures, weakness of the hallux flexion, and high instability of the MTP joint.(1,2)

Differential Diagnosis

Reverse turf toe or soccer toe, Hallux rigidus, Hallux limitus, Hallux valgus (9)

Diagnostic Procedures

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Outcome Measures

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Examination

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Key Research

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Recent Related Research (from Pubmed)

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