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Turf Toe

As we continue into the fall season of sports, a frequent injury we see in our clinic is "turf toe". Turf toe is a sprain of the first metatarsalphalangeal joint (MPJ) (big toe joint) resulting from the toe hyper-extending while planted. This injury results in disruption of the plantar structures of the first MPJ. The ligaments in the complex may become sprained or torn and the toe can become dislocated.

The initial injury usually occurs when the foot is planted and aggressive acceleration is placed across the joint. When the toe become planted in the "turf", it may fail to push off and instead extend beyond its normal range of motion. We see this injury most often in soccer and football, but it may occur in runners, baseball players or any athlete that begins a quick acceleration. Diagnosis is made by x-ray to look at the bony structures and bio-mechanics. This is usually followed by ultrasound or MRI to view the extent of the ligament damage.

The injury can be categorized into 3 grades known as the Baxter system:

-Grade 1 is a sprain of the plantar capsular ligaments. The athlete may be placed in a walking boot and advised to rest, ice, and take NSAIDs for pain. They can return to play as tolerated, but resting for 1-2 weeks is recommended. When the athlete returns to activity, the toe is splinted to limit the amount of flexion across the joint. A stiffer soled shoe and orthotics may also be recommended.

-Grade 2 is a partial tear/rupture of the soft tissue structures of the plantar first MPJ. The athlete is placed in a walking boot for 2-4 weeks to rest while continuing icing and NSAIDs. Similar precautions to grade 1 injuries apply when the athlete returns to activity.

-Grade 3 is a complete tear of the plantar ligaments with or without dislocation of the toe. This injury requires 10-16 weeks of limited or non-weight bearing in a boot or cast. In rare cases, surgery may be recommended to aid the repair.

The toe should also be analyzed for fractures to the sesamoids, tiny bones under the big toe, or damage to the bone in the big toe itself. Rest is essential to healing these injuries and professional athletes are often placed on temporary injured reserve lists while they recover. "Pushing through" this injury and playing through the pain may result in delayed healing and poor athletic performance. Amniotic injections and PRP have also been shown to decrease recovery time and help repairs. Athletes will benefit from custom orthotics after the injury has healed in order to offload the toe and increase functionality.

It is important to be patient with these injuries as they are slow healing and can be very limiting to the athlete. If you suspect you have turf toe, make an appointment today for an evaluation.

Chris Suykerbuyk, DPM, ACFAS

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