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. 2018 Sep 24;3(9):501-506.
doi: 10.1302/2058-5241.3.180012. eCollection 2018 Sep.

Turf toe: A clinical update

Ali-Asgar Najefi  1 , Luckshmana Jeyaseelan  1 , Matthew Welck  1
Affiliations

Turf toe: A clinical update

Ali-Asgar Najefi et al. EFORT Open Rev. .

Abstract

Turf toe is a condition that describes injury to the plantar metatarsophalangeal-sesamoid complex of the great toe.It is a relatively rare and debilitating condition, particularly seen in American footballers after the introduction of harder, artificial 'turf' surfaces.Turf toe represents a significant injury to the hallux and requires a high index of suspicion.If unrecognized, it can lead to chronic problems including reduced push-off strength, persistent pain, progressive deformity and eventual joint degeneration.Patients with chronic injuries may have worse outcomes, and therefore early, accurate diagnosis and initiation of treatment play a vital role.A multidisciplinary team approach is key for successful return to sport. Cite this article: EFORT Open Rev 2018;3:501-506. DOI: 10.1302/2058-5241.3.180012.

Keywords: football; hallux; plantar plate; push off; rehabilitation; rugby; sesamoid.

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Conflict of interest statement

ICMJE Conflict of interest statement: None declared.

Figures

Fig. 1
Fig. 1
Mechanism of injury to cause a turf toe - an axial load, on a hyperextended MTP joint, with fixed equinus at the ankle.
Fig. 2
Fig. 2
Normal AP radiograph of the right foot. It demonstrates the larger size of the medial sesamoid compared with the lateral sesamoid and it sits more distal. The medial hallux sesamoid is frequently bipartite.
Fig. 3
Fig. 3
Normal MRI images of the first MTP joint. The left image shows a sagittal T2 image and the right is a proton density-weighted coronal image. The plantar plate is the greatly thickened plantar capsule. The hallux MTP joint is dynamically stabilized by the short flexor complex (the FHB and the sesamoids embedded in the FHB tendons), the adductor hallucis and the abductor hallucis tendons. The FHB tendon inserts on the proximal phalanx in confluence with the plantar plate. As the FHB moves distally toward its insertion, the tendon envelops the medial (tibial) and lateral (fibular) sesamoids. The flexor hallucis longus tendon courses plantar to the metatarsal head, between the sesamoids in a separate sheath.
Fig. 4
Fig. 4
A sagittal T2 MR image demonstrating a grade 3 turf toe injury.
See this image and copyright information in PMC

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