Etiology and Biomechanics of First Metatarsophalangeal Joint Sprains (turf toe) in Athletes

Frimenko, Rebecca E.; Lievers, W. Brent; Coughlin, Michael J.; Anderson, Robert B.; Crandall, Jeffrey Richard; Kent, Richard W.

doi:10.1615/critrevbiomedeng.v40.i1.30

Cited by 34 publications

(9 citation statements)

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“…There are chronic sequelae associated with the injury, including an increased risk of recurrence, incomplete recovery and long-term stiffness (McCormick and Anderson, 2010a). An injury at this site can reduce an athlete's acceleration and mobility in the long term, due to impairment of biomechanical efficiency (Brophy et al, 2009;Coughlin et al, 2010;Frimenko et al, 2012).…”

Section: Is This Clinically Relevant? First Mtp Joint Pathologymentioning

confidence: 99%

“…Whilst injuries of the plantar plates of the forefoot have been well discussed and there have been recent articles detailing relevant biomechanics and pathophysiology (Bolgla and Malone, 2004;Carlson et al, 2000;Frimenko et al, 2012;Myerson and Badekas, 2000;Sarrafian, 1987;Shereff et al, 1986), the anatomy of the plantar plates of the hallux has not been subject to recent review.…”

Section: Introductionmentioning

confidence: 99%

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Properties and Function of the Flexor Hallucis Capsularis Interphalangeus Tendon

2019

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The fibrocartilagenous plantar plates of the forefoot are biomechanically important, forming the primary distal attachment for the plantar aponeurosis. They are integral to the function of the windlass mechanism in supporting the arches of the foot in gait. Dissection of the cadaveric hallux revealed an organised sagittal thickening of the dorsal side of the Flexor Hallucis Longus (FHL) sheath, which attached the interphalangeal plantar plate to the metatarsophalangeal (MTP) plantar plate. A description of a similar structure was made by McCarthy et al. in 1984 when it was termed the Flexor Hallucis Capsularis Interphalangeus (FHCI)-however, it has not been researched since, and we aim to study it further and identify its characteristics. Methods Eight specimens were dissected from four cadavers. Two were stained and examined under microscope and both polarized and non polarized light. The remaining 6 were subjected to micrometer testing of their tensile properties. Results Both the histological features and mechanical properties were consistent with tendon like substance, with cross sectional area, ultimate tensile strength and stiffness varying between specimens. Conclusions Based on its location and properties, the FHCI tendon may be involved in limiting dorsiflexion of the first MTP joint and could have clinical relevance in pathological processes around both the first and second MTP joints.

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Section: Is This Clinically Relevant? First Mtp Joint Pathologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Properties and Function of the Flexor Hallucis Capsularis Interphalangeus Tendon

2019

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“…There are a number of articles that provide an in-depth review of the anatomy, etiology and biomechanics of turftoe injury (Anderson, 2002;Childs, 2006;Clanton & Ford, 1994;Coughlin, Kemp, & Hirose, 2010;Frimenko et al, 2012;Jones & Reamer, 1999;McCormick & Anderson, 2010;Mullen & O'Malley, 2004). Therefore, only a brief overview of turf-toe injury will be presented here, with the primary focus on the method or mechanism by which forefoot bending stiffness may influence the incidence of turf-toe injury.…”

Section: Sprain Of the First Mtp Joint (Turf-toe)mentioning

confidence: 99%

The influence of forefoot bending stiffness of footwear on athletic injury and performance

Stefanyshyn

Wannop

2016

Footwear Science

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Forefoot bending stiffness is a footwear property that has recently been gaining interest despite previously receiving limited attention compared to other footwear characteristics. This review focuses on relevant research studies examining the influence of forefoot bending stiffness on reducing injury and optimizing performance. Discussion of the current limitations and need for future research within the realm of forefoot bending stiffness is also highlighted. By reducing the amount of metatarsophalangeal extension, increased bending stiffness could not only reduce injury risk (e.g. turf-toe), but also serve as a treatment for metatarsal stress fractures by offloading the metatarsals. However, there are surprisingly limited in-depth studies examining how altered forefoot bending stiffness influences injury. Many unknown factors still need to be studied including the appropriate magnitude of bending stiffness and the influence that altering forefoot bending stiffness may have on the injury risk of other joints such as the ankle and knee. Forefoot bending stiffness can influence performance; however, the exact mechanism remains unclear. Early studies focused on foot energetics, while recent studies have shown the importance of altering the movement of the centre of pressure under the foot and the gearing ratio at the ankle joint. There appears to be a specific amount of forefoot bending stiffness for optimal performance. Future research should focus on identifying the exact mechanism of performance improvement with modified bending stiffness to help determine how this optimal stiffness can be identified.

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“…Several authors have stated that the plantar plate performs the main role in maintaining joint stability in the sagittal plane. 1 , 2 , 3 , 4 Insufficiency or tearing of the plantar plate tends to evolve with some degree of deformity, in association with a high possibility of signs and symptoms. The main complaints among these patients are pain in the forefoot and some degree of deformity.…”

Section: Introductionmentioning

confidence: 99%

“…The main complaints among these patients are pain in the forefoot and some degree of deformity. 1 , 2 , 3 , 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

How to classify plantar plate injuries: parameters from history and physical examination

Nery

Coughlin

Baumfeld

et al. 2015

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo find the best clinical parameters for defining and classifying the degree of plantar plate injuries.MethodSixty-eight patients (100 metatarsophalangeal joints) were classified in accordance with the Arthroscopic Anatomical Classification for plantar plate injuries and were divided into five groups (0 to IV). Their medical files were reviewed and the incidence of each parameter for the respective group was correlated. These parameters were: use of high heels, sports, acute pain, local edema, Mulder's sign, widening of the interdigital space, pain in the head of the corresponding metatarsal, touching the ground, “drawer test”, toe grip and toe deformities (in the sagittal, coronal and transversal planes).ResultsThere were no statistically significant associations between the degree of injury and use of high-heel shoes, sports trauma, pain at the head of the metatarsal, Mulder's sign, deformity in pronation or displacement in the transversal and sagittal planes (although their combination, i.e. “cross toe”, showed a statistically significant correlation). Positive correlations with the severity of the injuries were found in relation to initial acute pain, progressive widening of the interdigital space, loss of “touching the ground”, positive results from the “drawer test” on the metatarsophalangeal joint, diminished grip strength and toe deformity in supination.ConclusionsThe “drawer test” was seen to be the more reliable and precise tool for classifying the degree of plantar plate injury, followed by “touching the ground” and rotational deformities. It is possible to improve the precision of the diagnosis and the predictions of the anatomical classification for plantar plate injuries through combining the clinical history and data from the physical examination.

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Etiology and Biomechanics of First Metatarsophalangeal Joint Sprains (turf toe) in Athletes

Cited by 34 publications

References 32 publications

Properties and Function of the Flexor Hallucis Capsularis Interphalangeus Tendon

Properties and Function of the Flexor Hallucis Capsularis Interphalangeus Tendon

The influence of forefoot bending stiffness of footwear on athletic injury and performance

How to classify plantar plate injuries: parameters from history and physical examination

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