Orthopedics Book

Blisters

Toes

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First Metatarsophalangeal Joint Sprain

Aka: First Metatarsophalangeal Joint Sprain, Great Toe MTP Sprain, Turf Toe
  1. Pathophysiology
    1. Usually due to forced hyperextension of great toe
    2. Often occurs on artificial turf (e.g. football)
  2. Symptoms
    1. Pain and swelling at first metatarsophalangeal joint
  3. 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
  4. Radiology: Great Toe XRay (weight bearing)
    1. Evaluate for conditions on differential diagnosis
  5. Differential Diagnosis
    1. Hallux Rigidus
    2. Sesamoid Stress Fracture
    3. Metatarsal Fracture
    4. Avulsion Fracture
  6. Complications
    1. Hallux Rigidus
  7. Management
    1. RICE-M
    2. Immobilize Grade 3 sprains for 1-2 weeks
      1. Follow with 4 to 6 weeks of relative rest
    3. Consider taping
    4. Consider rocker bottom sole to shoe
    5. Surgical intervention not usually indicated
  8. 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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