Injuries to the Great Toe
This review was intended to provide an overview of common and/or commonly missed injuries to the hallux with the aim of providing guidance for recent treatment principles.
The hallux metatarsophalangeal (MTP) joint provides balance and power in the toe-off phase during activities such as walking or jumping.
Injury to this complex can result in pain, weakness and instability which affects performance considerably.
Turf toe injuries occur due to hyperdorsiflexion of the hallux combined with an axial load – for instance, when a player falls back onto his own heel with his toe hyperextended and heel in equinus, or steps onto another player’s foot resulting in toe hyperextension.
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Due to the high loads placed on the plantar first metatarsal head along with the significant stresses placed across the first MTP joint during sports activities, the sesamoids are highly susceptible to fracture.
Sesamoid fractures can be classified as being either acute or stress; with acute fractures typically occurring in conjunction with significant turf toe injury.
The sesamoid region experiences substantial forces during running and jumping activities; when excessive or repetitive, this can result in inflammation of one or both of the sesamoids or surrounding soft tissues.
Typically presenting as forefoot pain in the toe-off phase of gait, avascular necrosis of the sesamoid is most commonly seen in women between ages 18 and 29 years.
Traumatic injury to the medial capsule, the abductor hallucis, the medial flexor hallucis brevis tendons or the ligamentous structures of the hallux, result from a significant valgus force or hyperadduction injury.
Toe phalangeal fractures occur at the distal phalanx and are most commonly because of a direct crushing type of injury.
While most injuries to the hallux can be treated with conservative measures such as off-loading, brief immobilisation and other modalities, a high index of suspicion is required when considering treatment strategies.
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References:
- York, P. J., Wydra, F. B., Hunt, K. J. (2017) Injuries to the Great Toe. Current Reviews in Musculoskeletal Medicine: March 2017, Vol. 10, No. 1, pp. 104-112. doi: 10.1007/s12178-017-9390-y
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