Turf Toe

Abstract

» Turf toe is a common injury in athletes. The prevalence of this injury has increased since the implementation of artificial turf and has been reported to be as high as 45% in professional football players.» The mechanism of injury, first described by Bowers and Martin in 1976, is hyperextension of the first metatarsophalangeal (MTP) joint, which causes disruption of the plantar structures. Turf toe can be classified as grade I, II, or III depending on the severity of the injury.» Patients typically present with tenderness, swelling, and/or loss of motion at the MTP joint. Physical examination includes palpation of the key structures surrounding the joint, along with varus and valgus stress and drawer testing of the MTP joint. Weight-bearing radiographs and magnetic resonance imaging are the most commonly utilized imaging modalities.» Turf toe typically is treated nonoperatively with rest, ice, nonsteroidal anti-inflammatory drugs, and compression. Operative treatment may be indicated when nonoperative measures are unsuccessful or in patients with severe disruptions of the plantar structures. Outcomes of turf toe are generally good, but in rare cases, the injury can be career-ending.» The purpose of this review is to highlight the current literature on the epidemiology, risk factors, classifications, diagnosis, treatment, and clinical outcomes of turf toe.

The Utility of Ultrasound in the Evaluation of Traumatic Hallux Valgus

“…Evidence-based treatment guidelines are lacking 19 ; however, conservative management is typically recommended for grade I and II MTP-1 injuries. 17,18,23,24,28 Corticosteroids are not recommended because of the risk of weakening soft tissues, masking pain, and risking worsening injury. 2,5,16,32 Despite increasing recognition of the risk of THV, 4,17,18,22,28 recommended stabilization has been either nonspecific (i.e., "taping") or only to prevent hyperextension.…”

“…17,18,23,24,28 Corticosteroids are not recommended because of the risk of weakening soft tissues, masking pain, and risking worsening injury. 2,5,16,32 Despite increasing recognition of the risk of THV, 4,17,18,22,28 recommended stabilization has been either nonspecific (i.e., "taping") or only to prevent hyperextension. 4,15,[17][18][19][22][23][24]28 Few studies recommend the use of a toe spacer or other method of preventing progressive valgus deformity.…”

“…2,5,16,32 Despite increasing recognition of the risk of THV, 4,17,18,22,28 recommended stabilization has been either nonspecific (i.e., "taping") or only to prevent hyperextension. 4,15,[17][18][19][22][23][24]28 Few studies recommend the use of a toe spacer or other method of preventing progressive valgus deformity. 25,31 Given that this is an N of 1, further study is warranted regarding application and efficacy of this preventative measure.…”

“…13 Despite many studies outlining the detailed anatomy, conservative management of MTP-1 injuries has been nonspecific. 2,5,[15][16][17][18][19][20][21][22][23] Only recently has there been an effort to consider the mechanism of injury and to evaluate the individual components of the plantar plate complex to achieve a more specific diagnosis, guide treatment, and prevent injury progression. [24][25][26][27][28][29] To the authors' knowledge, very few cases of valgus force causing isolated disruption of the medial collateral ligament (MCL) have been reported.…”

“…Both open 7–9 and closed 10–14 lateral collateral ligament injuries have occurred in taekwondo as well as combat training, 7 soccer, 14 and basketball 13 . Despite many studies outlining the detailed anatomy, conservative management of MTP-1 injuries has been nonspecific 2,5,15–23 . Only recently has there been an effort to consider the mechanism of injury and to evaluate the individual components of the plantar plate complex to achieve a more specific diagnosis, guide treatment, and prevent injury progression 24–29 .…”