Foot

First Metatarsophalangeal Joint Sprain

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First Metatarsophalangeal Joint Sprain, Great Toe MTP Sprain, Turf Toe

  • Pathophysiology
  1. Usually due to forced hyperextension of great toe
  2. Often occurs on artificial turf (e.g. football)
  • Symptoms
  1. Pain and swelling at first metatarsophalangeal joint
  • 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
  • Imaging
  • Great Toe XRay (weight bearing)
  1. Evaluate for conditions on differential diagnosis
  • Differential Diagnosis
  1. Hallux Rigidus
  2. Sesamoid Stress Fracture
  3. Metatarsal Fracture
  4. Avulsion Fracture
  • Complications
  1. Hallux Rigidus
  • 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
  • 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]