Injuries to the great toe

Abstract

Toe injuries have been found to represent nearly 10% of injuries presenting to fracture clinics. While most injuries can be treated nonsurgically, there are a number of specific injuries that require a high index of suspicion, careful management, and in some cases, surgical intervention. Injuries detailed in this review include turf toe, traumatic bunion, and hallux and sesamoid fractures. Additional pathologies that are covered include sesamoiditis and sesamoid avascular necrosis as well as hallux rigidus. Appropriate workup and current treatment recommendations are discussed. Injuries to the hallux can result in long-term pain and disability if not properly diagnosed and treated. A high index of suspicion is required.

Turf Toe Review

“…The hallux MTP joint is a hinged ball and socket articulation between the first metatarsal and its corresponding proximal phalanx. 7 Because of the shallow concavity of the base of the proximal phalanx, this articulation is relatively unstable and, therefore, relies on an additional 9 ligaments, 3 tendons, and 2 sesamoid bones to comprise a statically and dynamically stable first MTP joint complex. 12 The flexor hallucis brevis (FHB) originates from the plantar aspect of the cuboid and lateral cuneiform as well as from the posterior tibialis insertion over the medial and middle cuneiforms.…”

“…There are 2 collateral and 2 plantar ligaments that support the first MTP joint and sometimes an intra-articular meniscus that further enhances stability. 7,11,16 The collateral ligaments are important for stability of the MTP joint in cutting activities, whereas the plantar ligaments contribute to a thickening of plantar capsule and combine with the medial and lateral flexor tendon complexes to make up the plantar plate. This fibrocartilaginous structure comes from the head of the metatarsal at the distal portion of the sesamoids and attaches to the plantar base of the proximal phalanx.…”

“…8 The essential anatomy and structure of the first MTP joint is illustrated by its ability to sustain 40% to 60% of body weight during normal gait and 80% of body weight during the toe-off phase of normal walking. 7,14 Notably, this force can increase from 2 to 8 times the body weight when individuals are running and jumping. 17…”

“…It is postulated that the higher frictional properties of the artificial turf predispose athletes to injuries at this pivotal joint. 6,7 Although turf toe injuries display no ethno-cultural, sex-related, or age-related determinants, research has shown that various individual factors such as body weight, boney morphology and foot positioning, ankle and hallux range of motion, player position, shoe wear characteristics, and duration of professional football experience can contribute and predispose athletes to turf toe. 1,5,8-11 Although the reported incidence among professional and collegiate football players is variable, it is vital to determine appropriate identification and management strategies for these injuries to prevent long-term MTP dysfunction.…”

“…Differentiating mild injuries that are likely to do well with conservative management from those that require surgical intervention is essential to prevent long-term disability in this athletic population. 6,7…”