Turf Toe Review

Abstract

Turf toe is a term used to describe myriad injuries to the metatarsophalangeal complex of the great toe, which have been associated with the introduction of artificial turf surfaces in sport. If not diagnosed early and treated properly, these injuries can result in chronic pain and loss of mobility. Accurate injury grading through physical exam and advanced imaging is essential to guide treatment, thereby minimizing long-term complications and maximizing an athlete’s recovery and return to play. Levels of Evidence: Level V

Avulsión del ligamento colateral externo de la primera articulación metatarso-falángica en atleta femenino practicante de triatlón

“…85% de las lesiones resulta de la dorsiflexión forzada en la primera mtf, si el hallux se flexiona dorsalmente más allá de sus límites biomecánicos se producirá daño en la cápsula, ocasionando ruptura parcial o completa de la placa plantar, (lesión denominada dedo de césped), éstas se presentan frecuentemente en jugadores de futbol americano, con incidencia calculada de 0.062 por 1000. 1 Los mecanismos de lesión menos comunes incluyen la lesión por hiperflexión plantar de la primera articulación mtf y las lesiones por tensión en varo o valgo. Las lesiones por hiperflexión plantar se observan con mayor frecuencia en la danza y el voleibol de playa.…”

Presurgical Perspective and Postsurgical Evaluation of Plantar Plate and Turf Toe

“…3,13,14 The first MTP joint is crucial for an athlete to accelerate, jump, and change direction. 15 Established grading systems help classify severity of injury and determine rationales for conservative management, operative management, and protocols for return to sport. Imaging plays a crucial role in diagnosis and grading, helping determine injury management and planning return to sport.…”

“…15 The shallow concavity of the base of the proximal phalanx provides minimal osseous stability. 15 Static stability of the first MTP joint is provided by the capsuloligamentous structures and sesamoids and dynamically by the FHB, abductor hallucis, and adductor hallucis muscle-tendon units. 16 The medial and lateral sesamoids articulate with the plantar aspect of the metatarsal head at the medial and lateral metatarsal-sesamoid joints, respectively.…”

“…19 The plantar plate is a fibrocartilaginous thickening of the plantar capsule extending from the neck of the metatarsal to the base of the proximal phalanx. 15,20 The distal attachments of the plantar plate are broader and stronger than the thin proximal attachments. Medial and lateral metatarsosesamoid ligaments arise from the neck of the metatarsal and insert onto the medial and lateral sesamoids, respectively, indirectly supporting the plantar plate complex.…”

“…The FHB tendon splits into medial and lateral slips immediately proximal to the metatarsal head and merges with fibrous capsular tissue that envelops their respective sesamoid. 15,20 This increases the mechanical advantage of the FHB to facilitate load distribution and act as a shock absorber. 21,22 The abductor and adductor hallucis tendons insert onto the base of the proximal phalanx and have small attachments at the periphery of the medial and lateral sesamoids, respectively.…”