Turf Toe

Turf toe is a sprain of the plantar capsuloligamentous complex of the first metatarsophalangeal (1st MTP) joint, caused by forced hyperextension of the great toe.

It occurs in any sport played on firm surfaces, not only on artificial turf. Injuries range from a mild sprain (grade I) to complete plantar plate rupture with joint instability (grade III).

It is easily underestimated. Severe injuries can cause prolonged disability, chronic pain and post-traumatic hallux rigidus.

The plantar aspect of the first MTP joint is stabilised by the plantar capsuloligamentous complex.

The plantar plate, a thickened plantar capsule, is the main restraint to hyperextension. The medial (tibial) and lateral (fibular) sesamoids sit within the flexor hallucis brevis tendons under the first metatarsal head, joined by the intersesamoid ligament. The collateral ligaments and the abductor and adductor hallucis add side-to-side stability.

The classic mechanism is an axial load with the forefoot fixed on the ground, driving the great toe into hyperextension. A valgus component injures the medial structures and can lead to traumatic hallux valgus. A hyperflexion injury to the dorsal capsule is called sand toe.

Risk is highest with a hard, high-friction surface and a flexible shoe.

Grading:

• •Grade I: stretch; localised tenderness, mild swelling, stable
• •Grade II: partial tear; swelling, bruising, painful restricted movement
• •Grade III: complete tear, with or without sesamoid injury; marked swelling, weak flexion, unstable