Athletic Injuries of the First Metatarsophalangeal Joint
The purpose of this article was to describe the different injuries that occur to the first metatarsophalangeal joint, also known as “turf toe”.
Two case studies were also presented to illustrate these injuries.
The soft-tissue construct provides joint reinforcement that allows the hallux to support 40% to 60% of bodyweight during walking, and significantly greater forces during running and jumping.
While examining an athletic injury to the first metatarsophalangeal joint, the following items should be considered: the history of the injury, range of motion, area of maximum tenderness, medial and lateral collateral ligaments, sesamoid apparatus, stability of the joint, and radiographic examination.
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The first metatarsal carries twice the weight of any one lesser metatarsal, which is one-third the weight of the forefoot or one-sixth of the bodyweight.
Differential diagnoses for an injury to the first metatarsophalangeal joint include sprain or strain of the first metatarsophalangeal joint, osteochondral lesion, sesamoiditis, sesamoid fracture, dislocation, capsulitis, contusion and hallux limitus.
Initial treatment for turf-toe injuries should consist of protection, rest, ice, compression, elevation and support.
Non-steroidal anti-inflammatory drugs, turf-toe taping and stiff-soled shoes can be used during the weightbearing day to assist with mild injuries.
If the injury is minor, athletes may progress with gentle range-of-motion exercise and activities.
However, for more serious injuries, immobilization is required until the injury is stabilized.
If conservative measures fail, then surgical repair of the plantar capsule or removal of the loose body fragment is indicated.
Proper diagnosis is paramount for instituting appropriate treatment to facilitate an athlete’s prompt return to the playing field.
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References:
- Eugene R. Kubitz (2003) Athletic Injuries of the First Metatarsophalangeal Joint. Journal of the American Podiatric Medical Association: July/August 2003, Vol. 93, No. 4, pp. 325-332
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