Diastasis of Bipartite Sesamoids of the First Metatarsophalangeal Joint

Abstract

Injury to the metatarsophalangeal (MP) joint of the great toe, often termed "turf-toe", is a common occurrence in football. We have identified four cases of first MP plantar capsular injury with diastasis of a bipartite sesamoid. In three cases, observation and protection resulted in progressive widening of the fragments associated with pain and disability. These players required resection of the distal sesamoid fragment and repair of the volar capsule. The fourth player underwent acute repair of the medial retinaculum and capsule. All players have had a full return to sports activity. Diastasis of components of a partite sesamoid provides objective evidence of disruption of the plantar capsular mechanism. Early recognition of this condition confirmed by stress radiographs is recommended. Treatment may include early protection followed by resection, if painful, or acute repair of the retinaculum. Previous descriptions of turf-toe have not included injuries to the sesamoid complex of the first MP joint. In our opinion, the term turf-toe should represent the consequences of a hyperextension injury to the first MP joint in which the volar capsule has been disrupted proximal to the sesamoid. A classification for first MP joint injuries is presented.

A Review of Synthetic Playing Surfaces, the Shoe-Surface Interface, and Lower Extremity Injuries in Athletes

“…[29][30][31]33,34 Turf Toe Hyperextension injury of the metatarsophalangeal (MP) joint of the great toe is often referred to as "turf toe" 6 and is relatively common in football players. 35 The toe is most vulnerable to this injury when in dorsiflexion at the same time as the foot is in plantarflexion; any axial load then applied (eg, an offensive lineman falling onto the back of another player's heel) will force the great toe into hyperextension. Flexible shoes and hard playing surfaces are thought to be risk factors.…”

“…Plain radiographs can aid in diagnosis of sesamoid fracture or diastasis of a bipartite sesamoid. 35 Magnetic resonance imaging may be useful to confirm/rule out injury to the plantar capsuloligamentous structures.…”

Current Concepts Review: Traumatic Disorders of the First Metatarsophalangeal Joint and Sesamoid Complex

“…The combination of stiff artificial turf and flexible shoes is suspected to have led to the increased incidence of this injury. 6,9,24,25 Not all capsuloligamentous injuries of the first MTP joint are the result of pure dorsiflexion. When hyperdorsiflexion is combined with a valgus directed force, an acute traumatic hallux valgus deformity can develop.…”

Athletic injury to the first metatarsal phalangeal joint

“…With injury to the cartilage, progressive chrondrolysis and cystic changes are observed [8]. Progressive diastases of a bipartite sesamoid has been observed [14].…”