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Vazquez M, Henry S, Parot L, Subhawong T. Paediatric sand toe: radiographic, ultrasound and MRI findings of dorsomedial capsular injury. BMJ Case Rep 2023; 16:e253241. [PMID: 38129088 DOI: 10.1136/bcr-2022-253241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Hyperflexion injury to the metatarsophalangeal joint of the great toe, referred to as sand toe, can cause significant functional impairment. To our knowledge, there have been no radiological descriptions of this injury in the paediatric age group. Here, we report radiographic, sonographic and MRI findings in a male paediatric patient who sustained a sand toe injury, highlighting structural damage to the dorsomedial capsule and medial sagittal band, and discuss sand toe's favourable prognosis with conservative management.
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Affiliation(s)
- Manuel Vazquez
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephen Henry
- Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luis Parot
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ty Subhawong
- University of Miami Miller School of Medicine, Miami, Florida, USA
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Reeve A, Linklater JM, Dimmick DS. Lesser Metatarsophalangeal Joint Plantar Plate Degeneration and Tear and Acute First Metatarsophalangeal Joint Capsuloligamentous Injury: What the Surgeon Wants to Know. Semin Ultrasound CT MR 2023. [DOI: 10.1053/j.sult.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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3
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Khuc E, M Oloff L. First Metatarsophalangeal Joint Pathology in the Athlete. Clin Podiatr Med Surg 2023; 40:157-168. [PMID: 36368840 DOI: 10.1016/j.cpm.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Movement of the first metatarsophalangeal joint is an essential function of many sports. Because of the high demand on this relatively small joint, it is prone to the development of several notable pathologic derangements that can prevent full and pain-free athletic performance. A complete understanding of the joint anatomy and a careful physical examination and history collection is crucial to identifying an accurate diagnosis. Treatment should be pathology specific and should keep in mind the career expectations of the athlete.
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Affiliation(s)
- Emily Khuc
- Saint Mary's Medical Center San Francisco, Graduate Medical Office, 450 Stanyan Street, San Francisco, CA 94117, USA
| | - Lawrence M Oloff
- Saint Mary's Medical Center San Francisco, Graduate Medical Office, 450 Stanyan Street, San Francisco, CA 94117, USA; Palo Alto Medical Foundation 1501 Trousdale Drive, Ste 115, Burlingame, CA 94010, USA.
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Dimmick S, Reeve A, Linklater J. Presurgical Perspective and Postsurgical Evaluation of Plantar Plate and Turf Toe. Semin Musculoskelet Radiol 2022; 26:695-709. [PMID: 36791738 DOI: 10.1055/s-0042-1760221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Capsuloligamentous injury of the first metatarsophalangeal (MTP) joint (eponymously called "turf toe") mostly occurs in athletes and involves acute trauma, whereas tears of the lesser MTP joint plantar plate typically are an attritional-degenerative condition. This article reviews the anatomy, pathophysiology, mechanism and patterns of injury, grading and classification of injury, imaging appearances (pre- and postoperative), and management of first MTP joint capsuloligamentous injuries and lesser MTP joint plantar plate tears. These two distinct pathologies are discussed in separate sections.
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5
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The Utility of Ultrasound in the Evaluation of Traumatic Hallux Valgus. Am J Phys Med Rehabil 2022; 101:e145-e148. [PMID: 35836317 DOI: 10.1097/phm.0000000000002073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Isolated disruption of the medial collateral ligament of the great toe is rare and often misdiagnosed as turf toe. It may progress to acquired traumatic hallux valgus, often requiring operative intervention and a longer return to play. This case of a grade II medial collateral ligament injury highlights the importance of a thorough physical examination and consideration of the mechanism of injury. It demonstrates the utility of diagnostic musculoskeletal ultrasound in establishing a specific diagnosis upon initial patient presentation with great toe pain. It is an example of the use of ultrasound in guiding treatment and monitoring interval healing. In this case, differentiation of the injury from the classic "turf toe" led to proper stabilization with a toe spacer and activity modification, thus preventing progression of traumatic hallux valgus and leading to successful nonoperative treatment with full return to sport. LEVEL OF EVIDENCE Level V.
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Schafer KA, McCormick JJ. Turf Toe and Sesamoiditis. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Wang JE, Bai RJ, Zhan HL, Li WT, Qian ZH, Wang NL, Yin Y. High-resolution 3T magnetic resonance imaging and histological analysis of capsuloligamentous complex of the first metatarsophalangeal joint. J Orthop Surg Res 2021; 16:638. [PMID: 34689814 PMCID: PMC8543817 DOI: 10.1186/s13018-021-02795-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are discrepancies in the understanding of the structure of the capsuloligamentous complex of the first metatarsophalangeal joint (MTPJ); this study aims to investigate the differences with previous anatomical reports of high-resolution 3T magnetic resonance imaging (MRI) and histological analysis in illustrating the structure of the capsuloligamentous complex of the first MTPJ. Methods Nine fresh frozen cadaveric feet specimens (from two women and three men; aged 32 to 58 years) were used in this study. All specimens underwent MR examination with T1-weighted imaging and T2-weighted spectral attenuated inversion recovery in three planes. Subsequently, all cadaveric feet specimens were sliced into 2-mm-thick sections. The MRI features of the capsuloligamentous complex of the first MTPJ were analyzed in these specimens. Hematoxylin–eosin and Masson’s trichrome staining methods were used to explore the histologic features of the capsuloligamentous complex of the first MTPJ. Results Different from most previous studies, our results showed that the plantar plate could be divided into four portions including the central portion of the plantar plate, the intersesamoid, the sesamoid phalangeal and the metatarsosesamoid ligaments. The normal central portion of the plantar plate could be clearly visualized in the sagittal and coronal plane MR images. The intersesamoid ligament is a continuation of the central portion of the plantar plate on the sagittal plane on the gross specimen, the MR imaging, and the histological examination. On the coronal plane of the gross specimen and MR imaging, the sesamoid phalangeal ligaments and the central portion of the plantar plate can be seen as separate ligaments, but they appeared interwoven with the same continuous collagenous fibers on the histological analysis. Conclusion High-resolution 3T MRI allows accurate demonstration of the different anatomical details of the capsuloligamentous complex of the first MTPJ from previous anatomical reports. The histological analysis provides further understanding of the structures of the capsuloligamentous complex of the first MTPJ from previous studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02795-7.
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Affiliation(s)
- Jin-E Wang
- Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China
| | - Rong-Jie Bai
- Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China. .,Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Hui-Li Zhan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Wen-Ting Li
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Zhan-Hua Qian
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Nai-Li Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Yuming Yin
- Direct Radiology, 3501 Ocean Drive, Corpus Christi, TX, 78411, USA
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Abstract
Turf toe is a common injury of the hallux metatarsophalangeal (MTP) joint in athletes which is the result of hyperdorsiflexion injury. While the term turf toe has been used to describe a variety of first MTP joint injuries, the term is now typically used in imaging to describe tearing or injury to the plantar plate complex. This review article will cover normal anatomy of the first MTP joint, mechanism of injury, typical imaging findings in normal individuals on MRI and ultrasound, as well as the most common patterns of injury.
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Affiliation(s)
- Michael T Perry
- Department of Radiology and Medical Imaging, University of Virginia, PO Box 800170, Charlottesville, VA 22908, USA.
| | - Jennifer L Pierce
- Department of Radiology and Medical Imaging, University of Virginia, PO Box 800170, Charlottesville, VA 22908, USA
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Hallinan JTPD, Statum SM, Huang BK, Bezerra HG, Garcia DAL, Bydder GM, Chung CB. High-Resolution MRI of the First Metatarsophalangeal Joint: Gross Anatomy and Injury Characterization. Radiographics 2020; 40:1107-1124. [PMID: 32412828 DOI: 10.1148/rg.2020190145] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The first metatarsophalangeal joint (MTPJ) is vital to the biomechanics of the foot and supports a weight up to eight times heavier than the body during athletic activities. The first MTPJ comprises osseous and cartilaginous surfaces along with a complex of supporting structures, including the dorsal extensor tendons, collateral ligaments, and a plantar plate complex. In contradistinction to the lesser MTPJ plantar plates, a single dominant fibrocartilaginous capsular thickening does not exist at the first MTPJ. Instead, the plantar plate complex comprises a fibrocartilaginous pad that invests the hallux sesamoids and is inseparable from the plantar capsule, the intersesamoid ligament, paired metatarsosesamoid and sesamoid phalangeal ligaments (SPLs), and the musculotendinous structures. Acute injury at the first MTPJ is typically secondary to forced hyperextension-turf toe-and can involve multiple structures. During hyperextension, the resulting forces primarily load the distal SPLs, making these structures more susceptible to injury. SPL injuries are best seen in the sagittal plane at MRI. Radiography can also aid in diagnosis of full-thickness SPL tears, demonstrating reduced sesamoid excursion at lateral dorsiflexed (stress) views. Hallux valgus is another common condition, resulting in progressive disabling deformity at the first MTPJ. Without appropriate treatment, first MTPJ injuries may progress to degenerative hallux rigidus. The authors detail the anatomy of the first MTPJ in cadaveric forefeet by using high-resolution 3-T and 11.7-T MRI and anatomic-pathologic correlation. Injuries to the plantar plate complex, collateral ligaments, and extensor mechanism are discussed using clinical case examples. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- James T P D Hallinan
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Sheronda M Statum
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Brady K Huang
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Higor Grando Bezerra
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Diego A L Garcia
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Graeme M Bydder
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Christine B Chung
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
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10
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Abstract
Turf toe is a term used to describe myriad injuries to the metatarsophalangeal complex of the great toe, which have been associated with the introduction of artificial turf surfaces in sport. If not diagnosed early and treated properly, these injuries can result in chronic pain and loss of mobility. Accurate injury grading through physical exam and advanced imaging is essential to guide treatment, thereby minimizing long-term complications and maximizing an athlete's recovery and return to play. Levels of Evidence: Level V.
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Affiliation(s)
- Daniel Chiou
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (DC).,Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts (KLS, GW)
| | - Kristen L Stupay
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (DC).,Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts (KLS, GW)
| | - Gregory Waryasz
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (DC).,Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts (KLS, GW)
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Nery C, Fonseca LF, Gonçalves JP, Mansur N, Lemos A, Maringolo L, Fonseca LF. First MTP joint instability - Expanding the concept of "Turf-toe" injuries. Foot Ankle Surg 2020; 26:47-53. [PMID: 30509556 DOI: 10.1016/j.fas.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/04/2018] [Accepted: 11/09/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the classic definition of the Turf-toe injury refers to a very specific clinical and pathological picture, we think that the concept can be broadened to encompass a wide variety of traumatic lesions of the first metatarsophalangeal joint (MTP1). These are lesions typically difficult to diagnose, with a large variation of outcomes and a potential to impair patients' functional performance on a definitive and perennial basis. The objective of this study is to present the result obtained by treating 24 cases of traumatic injuries to the MTP1 joint in a midterm follow-up time. METHODS In the period from 1999 to 2016, 24 patients were treated with MTP1 joint instability - "Expanded Turf-toe" - diagnosis. All patients were performing sports activities when they were injured: soccer (33%); martial arts (17%); running (13%); tennis (8%); olympic gymnastics (8%) and others (basketball, slalom, motorcycling, surfing, and ballet) (21%). Injuries were classified as Grade I (2 patients - 8%), Grade II (8 patients - 33%) and Grade III (14 patients - 59%) lesions. All patients with grades I and II were treated conservatively whereas those classified as grade III were treated surgically. RESULTS After an average follow-up of 4.5 years we observed an improvement in the AOFAS hallux score from 42 to 82 points after treatment (p<0.001). The most frequent cause was axial load with various direction of stress at the first MTP. The mechanism of lesion varied among extension with hallux varism (42%), pure hyperextension (25%), extension with hallux valgism (21%), pure hyperflexion (8%) and hyperflexion with hallux valgism (4%). A separate analysis of each group showed a significant improvement in AOFAS Hallux scores after treatment: 51-84 (p<0.001) and 36-81 (p<0.001) for conservative and surgical groups, respectively. Four patients with GIII injuries (29%) and two with GII injuries (20%) did not resume their previous activities. Although pre-treatment AOFAS hallux scores were significantly different between groups, post-treatment scores were similar (p=0.615). CONCLUSIONS Turf-toe is a serious injury that may prevent a high percentage of patients from resuming their previous physical activities. Mechanism of lesion might be varied generating a wide range of lesions that fit into the expanded concept of the Turf-toe injury. Both forms of treatment lead to satisfactory results if well conducted. The correct identification, classification, and grading of first metatarsophalangeal joint (MTP) instability helps in decision making and selection of the adequate treatment. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Caio Nery
- Orthopedics and Traumatology Department of UNIFESP - Paulista Medical School, Brazil.
| | - Lucas F Fonseca
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - João Paulo Gonçalves
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - Nacime Mansur
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - André Lemos
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - Leonardo Maringolo
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
| | - Lucas F Fonseca
- Ankle and Foot Medicine and Surgery of UNIFESP - Paulista Medical School, Brazil
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Poppe T, Reinhardt D, Tarakemeh A, Vopat BG, Mulcahey MK. Turf Toe: Presentation, Diagnosis, and Management. JBJS Rev 2019; 7:e7. [PMID: 31436580 DOI: 10.2106/jbjs.rvw.18.00188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tanner Poppe
- Department of Orthopedics, University of Kansas School of Medicine, Kansas City, Kansas
| | - Daniel Reinhardt
- Department of Orthopedics, University of Kansas School of Medicine, Kansas City, Kansas
| | - Armin Tarakemeh
- Department of Orthopedics, University of Kansas School of Medicine, Kansas City, Kansas
| | - Bryan G Vopat
- Department of Orthopedics, University of Kansas School of Medicine, Kansas City, Kansas
| | - Mary K Mulcahey
- Department of Orthopedics, Tulane University School of Medicine, New Orleans, Louisiana
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Abstract
This article reviews the imaging aspects relevant to ligamentous instabilities of the foot and ankle with a focus on MRI and ultrasound imaging. A pictorial review of the anatomy of the medial and lateral ankle ligaments, syndesmosis, spring ligament, Lisfranc complex, hallux sesamoid complex, and lesser toe plantar plate as seen on MRI is presented. Selected cases of ligamentous pathology relevant to foot and ankle instability are presented. The value of imaging in the assessment of foot and ankle instability is reviewed.
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Affiliation(s)
- Peter Salat
- Department of Radiology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada; Mayfair Diagnostics, 6707 Elbow Drive Southwest 132, Calgary, Alberta T2V 0E3, Canada.
| | - Vu Le
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Mark E Cresswell
- Department of Radiology, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
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Ashimolowo T, Dunham G, Sharp JW, Porrino J. Turf Toe: An Update and Comprehensive Review. Radiol Clin North Am 2018; 56:847-858. [PMID: 30322486 DOI: 10.1016/j.rcl.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Turf toe is a spectrum of injury involving the first metatarsophalangeal joint originally described in football players on artificial surfaces. A detailed description of the complex anatomy and pathology involved in the turf toe injury is presented. We highlight potential pitfalls of image interpretation and emphasize what the referring physician needs to know.
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Affiliation(s)
- Tolu Ashimolowo
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-7117, USA
| | - Gregor Dunham
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-7117, USA
| | - Jake W Sharp
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-7117, USA
| | - Jack Porrino
- Radiology and Biomedical Imaging, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA.
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15
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Abstract
BACKGROUND Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. METHODS We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. RESULTS The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. CONCLUSION Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kenneth Smith
- 1 University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Norman Waldrop
- 2 American Sports Medicine Institute, Birmingham, AL, USA
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16
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Marchetti DC, Chang A, Ferrari M, Clanton TO. Turf Toe: 40 Years Later and Still a Problem. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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