Remote Fellowship – Foot & Ankle Fundamentals – 11/2/2020
Case 5 – Discussion
“Turf toe” is a traumatic hyperextension injury of the hallux (i.e., great toe). It typically results from an axial load placed on the heel of a plantarflexed foot, resulting in hyperextension of the 1st metatarsophalangeal joint. This causes injury to the plantar capsuloligamentous complex ranging from a sprain to complete rupture, and, if left untreated, may result in hallux valgus or varus, FHL tendon tear, and degenerative joint disease.
Turf toe injuries can be divided into 3 separate grades based on severity:
– Grade 1: stretch or minor tearing of the capsuloligamentous structures
– Grade 2: partial tearing of the capsuloligamentous structures with intact articular surface. Attempts should be made to grade the percent of tear based on how much plantar plate can be seen transversely or from side to side when possible.
– Grade 3: complete rupture of the capsuloligamentous structures with damage to the articular cartilage, edema, and possible sesamoid fracture
MRI is recommended for patients with abnormalities seen on radiography, as well as those with grade II and III injuries. MRI findings of turf toe injuries can include increased signal intensity in and around the plantar capsuloligamentous complex on both T1- and T2-weighted images, discontinuity of the plantar capsuloligamentous complex, proximal retraction and/or fracture of the sesamoids, and synovitis within the flexor tendon sheath and metatarsophalangeal joint. Sagittal sequencing best depicts tears of the medial and lateral sesamoid phalangeal ligaments, short-axis sequencing best depicts tears of the metatarsosesamoid ligament, and long axis sequencing best reveals tears of the medial collateral ligament.
Turf toe in a 30-year-old man sustaining an injury to the right great toe while playing football 1 day prior.
- Anderson J. Turf toe injuries of the hallux metatarsophalangeal joint. Techniques in Foot & Ankle Surgery 2002; 1(2):102-111
- Linklater J. Imaging of sport injuries in the foot. American Journal of Roentgenology 2012; 199:200-508