Injuries to the great toe

Abstract

Purpose of review: Injuries to the great toe are common in athletes. While most are managed nonoperatively and allow return to sports activity, some great toe injuries are highly problematic and can impact function. The purpose of this review is to highlight several specific injuries and disease processes involving the hallux and to detail current recommendations and management options in order to help raise suspicion for injuries that can result in long-term dysfunction.

Recent findings: Toe injuries have been found to represent nearly 10% of injuries presenting to fracture clinics. While most injuries can be treated nonsurgically, there are a number of specific injuries that require a high index of suspicion, careful management, and in some cases, surgical intervention. Injuries detailed in this review include turf toe, traumatic bunion, and hallux and sesamoid fractures. Additional pathologies that are covered include sesamoiditis and sesamoid avascular necrosis as well as hallux rigidus. Appropriate workup and current treatment recommendations are discussed. Injuries to the hallux can result in long-term pain and disability if not properly diagnosed and treated. A high index of suspicion is required.

Keywords: Fracture; Hallux injury; Sesamoids; Traumatic bunion; Turf toe.

Fig. 1

Illustrations of common turf to injury mechanisms, including a MTP joint hyperdorsiflexion when the forefoot collides with another shoe. b MTP is hyperdorsiflexed as the player lands with the great toe dorsiflexed with impact on the heel from self or another player

Fig. 2

Images illustrating bipartite sesamoid intersesamoid sprain. a Initial AP radiograph suggesting bipartite sesamoid and MRI suggesting inter-bitartite sesamoid separation. b Contralateral foot radiographs revealing bitartite sesamoid. c Follow-up radiographs after 6 weeks of conservative treatment without improvement in symptoms. Callus formation suggests fracture

Fig. 3

Nonoperatively treated sesamoid fracture in collegiate football player. a Injury film. b Three months post-injury

Fig. 4

Photographs of surgically treated sesamoid fracture illustrating a plantar incision lateral to the fibular sesamoid and b the fracture site debrided of fibrous tissue (Images courtesy of Loretta Chou, MD)

Fig. 5

a Radiographs demonstrating fragmentation of the fibular sesamoid with early degenerative changes in the MTP joint. b T2-weighted MRI revealed heterogeneous, hyperintense signal within the sesamoid

Fig. 6

Traumatic hallux valgus with avulsion fracture at the base of the proximal phalanx

Fig. 7

Post-op radiograph demonstrating correction of hallux valgus after removal of the fragment, medial tissue repair with abductor advancement

Fig. 8

a Injury radiographs illustrating displaced proximal phalanx fracture of the great toe following direct impact trauma. b Post-operative radiographs following closed reduction with percutaneous pin fixation