II. Pathophysiology

  1. Usually due to forced hyperextension of great toe
  2. Often occurs on artificial turf (e.g. football)

III. Symptoms

  1. Pain and swelling at first metatarsophalangeal joint

IV. Signs: Grading

  1. Grade 1: First MTP capsule stretched
    1. Mild symptoms
    2. Athlete usually able to continue sports participation
  2. Grade 2: MTP plantar ligamentous complex partial tear
    1. Swelling and Ecchymosis
    2. MTP range of motion decreased
  3. Grade 3: MTP plantar ligamentous complex complete tear
    1. Significant swelling and Ecchymosis
    2. Significantly limited MTP range of motion
    3. Patient has difficulty even walking

V. Imaging: Great Toe XRay (weight bearing)

  1. Evaluate for conditions on differential diagnosis

VI. Differential Diagnosis

VII. Complications

VIII. Management

  1. Low grade sprains heal in weeks
    1. High grade sprains may require immobilization
  2. RICE-M
  3. Immobilize Grade 3 sprains for 1-2 weeks
    1. Follow with 4 to 6 weeks of relative rest
  4. Consider taping
  5. Consider rocker bottom sole to shoe
  6. Surgical intervention not usually indicated

IX. References

  1. DeLee (2003) Orthopedic Sports Medicine, p. 2504-10
  2. Greene (2001) Musculoskeletal Care, AAOS, p. 516-7
  3. Title (2002) Orthop Clin North Am 33:587-98 [PubMed]

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