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Gupta A, Singh PK, Xu AL, Bronheim RS, McDaniel CM, Aiyer AA. Turf Toe Injuries in the Athlete: an Updated Review of Treatment Options, Rehabilitation Protocols, and Return-to-Play Outcomes. Curr Rev Musculoskelet Med 2023; 16:563-574. [PMID: 37789169 PMCID: PMC10587038 DOI: 10.1007/s12178-023-09870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW First metatarsophalangeal joint sprains or turf toe (TT) injuries occur secondary to forceful hyperextension of the great toe. TT injuries are common among athletes, especially those participating in football, soccer, basketball, dancing, and wrestling. This review summarizes the current treatment modalities, rehabilitation protocols, and return-to-play criteria, as well as performance outcomes of patients who have sustained TT injuries. RECENT FINDINGS Less than 2% of TT injuries require surgery, but those that do are typically grade III injuries with damage to the MTP joint, evidence of bony injury, or severe instability. Rehabilitation protocols following non-operative management consist of 3 phases lasting up to 10 weeks, whereas protocols following operative management consist of 4 phases lasting up 20 weeks. Athletes with low-grade injuries typically achieve their prior level of performance. However, among athletes with higher grade injuries, treated both non-operatively and operatively, about 70% are expected to maintain their level of performance. The treatment protocol, return-to-play criteria, and overall performance outcomes for TT injuries depend on the severity and classification of the initial sprain. For grade I injuries, players may return to play once they experience minimal to no pain with normal weightbearing, traditionally after 3-5 days. For grade II injuries, or partial tears, players typically lose 2-4 weeks of play and may need additional support with taping when returning to play. For grade III injuries, or complete disruption of the plantar plate, athletes lose 4-6 weeks or more depending upon treatment strategy.
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Affiliation(s)
- Arjun Gupta
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Priya K. Singh
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
- Department of Orthopaedic Surgery, Montefiore Medical Center at Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY 10461 USA
| | - Amy L. Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Rachel S. Bronheim
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Claire M. McDaniel
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
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Tan EW, Bolia IK, Peterson AB, Korber S, Romano R, Weber AE, Gamradt SC, Thordarson DB. Return to Sport Following Operative Treatment of Displaced Medial Sesamoid Fractures in NCAA Division I Football Players. Foot Ankle Int 2021; 42:654-657. [PMID: 33557611 DOI: 10.1177/1071100720978751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: Level V.
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Affiliation(s)
- Eric W Tan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander B Peterson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Shane Korber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Russ Romano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - David B Thordarson
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 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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