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. Radiology: Great Toe XRay (weight bearing)

  1. Evaluate for conditions on differential diagnosis

VI. Differential Diagnosis

VII. Complications

VIII. 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

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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