Discussion:
- Turf toe is a tear of the joint capsule from the MT head which results in subluxation or dislocation of the first MTP joint.
- Caused by hyperextension (most common), hyperflexion or valgus injury.
- Associated with decreased ROM at first MTP joint and its sequele can include hallux rigidus and can exacerbate sesamoiditis.
- Turf toe can be an extremely debilitating injury in competitive football players.
Radiographs:
- With dislocation of the MTP joint without sesamoid fracture, anticipate difficulty with closed reduction.
Treatment of Hyper-extension Injuries:
- Activities are reduced for 3 weeks, and afterwards the patient must wear an orthosis that blocks dorsiflexion during atheletic activities.
Dislocations:
- Dislocations of hallux MTP joint are classified based on x-ray appearance of the sesamoids.
Type I:
- Plantar plate ruptures at its proximal attachment to metatarsal neck and dislocates with attached sesamoids riding over the metatarsal head.
- Plantar plate-sesamoid complex follows the proximal phalanx.
- Metatarsal head can buttonhole into the plantar capsule which prevents closed reduction.
- Disruption of volar plate - sesamoid complex.
- No sesamoid fracture.
- No widening of inter-sesamoid space.
- Reduction is blocked by the interposed volar plate.
- Open reduction is performed through dorsal approach.
Type II:
- Widening of inter-sesamoid interval.
- Closed reduction is usually possible.
Type II:
- Transverse fracture through the sesamoids.
- Closed reduction is usually possible.