Evaluation and treatment of turf toe injuries

Turf toe refers to an injury to the first metatarsal phalangeal joint or first MTP joint.  This may occur during sports when the great toe catches on the ground and is forced downward into what we would describe as hyper plantar flexion.  When this occurs the capsule and ligaments on the top or dorsal aspect of the joint line or strained or torn.  There could even be an avulsion type chip of bone that is torn or pulled with the ligament.  This also could include any injury to the capsule of the great toe joint in this location.  In general this is different than a sesamoid injury.  Sesamoids are the small bones on the bottom of the great toe joint.

 When the capsule is torn on the first MTP joint, it is a lot like a sprain of an ankle joint ligament or capsule.  The joint can become stiff, swollen and painful.

Just like an ankle injury, the goal is to protect it and allow the capsule to heal.  This is often accomplished with a cast boot.

In addition, with any acute injury icing is helpful initially along with a cast boot and resting.

Therefore any exercise that is done should be nonimpact.  Examples could include aqua jogging.  Another example could include cycling but using the pedal in the arch or even the heel area and avoiding the forefoot.  In general one should wait to do any of these nonimpact exercise until after the acute phase of the initial 3-5 days is over.

 Note that after the initial phase with a cast boot but could vary from 2 weeks to 4 weeks or longer, one can transition to a stable athletic shoe, or hiking boot that has a stiffer forefoot to protect the great toe joint.

Physical therapy may be helpful to reduce swelling and to promote healing. 

 Because the great toe joint is prone to mechanical jamming and long-term arthritis, it is important to treat turf toe aggressively and make certain that symptoms completely resolve.  In addition, to addressing the mechanics of this joint, it is helpful to use a prescription orthotics to offload and protect the joint from mechanical jamming.

And, if the joint has any tendency for stiffness then synthetic joint lubricant such as Supartz or Synvisc is recommended.

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