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Turf Toe

What is "turf toe" and how should it be treated?

Answer, provided by Thomas E. Shonka, DPM, Past President, AAPSM.

Q: Several of my athletes (over the past few years) have been diagnosed with "Turf Toe." It seems as if they all had slightly different treatment programs and significantly different outcomes.

A: You've stated the question well. Just as "Shin-Splints" will broadly refer to pain
between the knee and ankle, "Turf Toe" refers to pain associated with injury to the big toe joint.

The first metatarsal-phalangeal joint, or 1st MTPJ, is an incredibly complex joint. It is the primary location of propulsive and pivoting forces exerted in the ball of the foot. The first (thickest and strongest) metatarsal bones forms a joint, not only with the big toe but also with the two small "sesamoid" bones under the head of the metatarsal. The sesamoids function as miniature kneecaps, assisting in flexion of this joint. They form the weight-bearing part of this joint and as such, are frequently injured. When one considers the seven tendons, the complex of ligaments, the joint surfaces, nerves, and the bones themselves, it's easy to understand how one case of "Turf Toe" would be handled differently from another.

Whenever an athlete injures the 1st MTPJ, the first question on evaluation would be in regards to the mechanism of injury. While a direct axial loading of the joint may damage joint surfaces, a hyperextension injury (the big toe forcibly pushed upwards) may very well injure the sesamoids.

Clinical evaluation of the injured area will yield information necessary to determine specific injured structures. Most often x-ray evaluation will be performed. On occasion, advanced imaging studies such as bone scan, CT scan  or MRI will be employed. Less frequently, laboratory testing of blood will be indicated.

Certainly, the goal of treatment is to return the athlete to competition,  without risk of further injury. Once the nature of the injury has been determined, appropriate treatment is instituted. Most frequently, rest, anti-inflammatory care, and immobilization will be required. The use of spring steel insoles or more frequently, prescription foot orthotics, will often aid a return to athletics.

It is beyond the scope of this Q&A forum to delve into an in-depth explanation of treatment course for all 1st MTPJ pathology. However, I encourage you to reference the list of AAPSM Fellows and Members on this web site for specific case information. Thank you.

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