Turf - Toe
Turf Toe is a sprain of the metatarsophalangeal (MTP) joint of the first toe. That is, the joint of the toe to the foot is sprained. The injury usually results from a hyperflexion mechanism; the toe is bent to far upward. This can result from a hard push off on a rigid surface, having the toe forcibly flexed while being tackled, or by stopping short allowing the toe to jam in the toe box of the shoe. These mechanisms cause damage to the ligaments of the joint and the joint capsule.
The 1st MTP joint is instrumental in all sports that involve foot contact with the ground. The Great Toe is the final structure in contact with the ground on push-off. Due to this, up to 8 X a person’s body weight may be transferred through the 1st MTP joint. Contact sport athletes are at a greater risk of injury of the 1st MTP due to the possibility that during contact, the joint may be forcibly hyperflexed.
The joint is comprised of 4 bones, 9 ligaments, and 3 muscular attachments. This makes for a very complex joint. Of the 4 bones, 2 are sesamoid bones that are encapsulated within tendon. A common example of a sesamoid is the patella or knee cap. Sesamoids serve as fulcrums to increase the power of the muscles that cross them.
The sesamoids are contained within the Flexor Hallucis Brevis tendon and are connected to the under side of the toe by a ligament. Other muscles of the Great Toe are the Adductor Hallucis and Abductor Hallucis. The ligaments of the 1st MTP are comprised of 2 collaterals (located on either side of the joint) and two plantar (on the underside) ligaments. Their attachments combined with the muscular attachments make the great toe a strong yet flexible structure.
It is the amount of flexibility that may lead to easier injuries. The great toe usually has approximately 80º of flexion. It is when this normal range is passed that injury occurs. Another factor in the injury process is the amount of support offered by the athlete’s shoes. Worn out shoes allow too much freedom of motion in the forefoot area. This lack of support will assist in transference of forces from the shoe to the foot, increasing the likelihood of injury.
The amount of force is directly proportional to the extent of the injury. The grades of injury are listed in the table below.
Treatment of the injury begins with proper assessment of the extent of the injury. Determining if it is a 1st, 2nd, or 3rd degree sprain is instrumental in returning the athlete to play that day or scheduling a physician’s appointment.
The immediate treatment for all grades of sprains is the same, Rest, Ice, Compression, and Elevation. This is the standard for acute care of any athletic injury.
First Degree Sprains
A 1º sprain usually results in very little time loss. The athlete must be able to run and change direction properly prior to return to competition. Application of ice and taping the toe may be enough treatment for return to competition on the day of the injury. Also, spring steel shoe inserts can be of great benefit to reduce the forces applied to the joint.
Second Degree Sprains
This type of injury often leads to time loss. This is due to the greater amount of tissue damage suffered. This athlete may need crutches for walking, and should be seen by a physician to rule out a bony fracture. When the athlete can run and change direction with out pain and loss of mobility, he/she may return to participation with the toe taped and a steel shoe insert.
Third Degree Sprains
These injuries are severe and may be a season ending injury. It must be determined if the joint surfaces have been damaged. If so, early return to participation may result in severe degenerative arthritis, and the loss of a career. Surgery may be required to repair the torn ligaments and tendons.
Rehabilitation for this injury is fairly simple. Acutely, ice and restriction of motion of the joint is critical in the healing process. As mentioned previously, crutches for walking may be necessary for a period of 1 - 2 weeks.
After the acute stage, it is necessary to return full strength and range of motion to the toe, foot, and ankle. During the acute phase lower body strength and endurance will decrease. Utilizing a stationary bicycle for aerobic conditioning is advised. Strength training in a non-weight bearing fashion for the affected limb is also appropriate. The strength of the foot and ankle should be addresses with Theraband® and range of motion exercises.
For the 1st MTP itself, gentle range of motion exercises should be instituted as pain allows. These are necessary to prevent Hallux Rigidus, a condition that arises when the joint is not moving properly. This can also result in degenerative arthritis of the MTP. Have the athlete bend the toe gently within the limits of pain. As the pain decreases, the amount of motion increases.
As mentioned previously, toe taping and spring steel shoe inserts will assist in supporting the toe and allow the athlete to return to participation sooner.
©2000 - 2009 David Edell
Information on this site is not a substitute for physician directed care.
Please consult your personal physician for more detailed information
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Last Update for AthleticAdvisor.com: 10/24/2009 12:09:35 AM