Turf toe is an extreme traumatic dorsiflexion (hyperextension) injury of the toe results in plantar plate injury from sprain to complete tear of the plantar plate capsuloligamentous complex and allows unrestricted range of motion of the first metatarsophalangeal (MTP) joint. It is common in professional athletes, especially on artificial surfaces and is not particular to a specific sport, but is commonly seen in football, soccer, and baseball players.
The mechanism in typical turf toe injuries is one of extreme traumatic dorsiflexion (hyperextension), often with some varus or valgus angulation superimposed, which causes disruption of the plantar plate capsuloligamentous complex and allows unrestricted range of motion of the first metatarsophalangeal (MTP) joint. Occasionally, fracture of the sesamoids or separation of bipartite sesamoids can be seen.
Many variants of turf toe injury have been described and include
- valgus mechanism with injury of the medial capsuloligamentous structures
- varus mechanism with injury of the lateral capsuloligamentous structures and adductor hallucis tendon
- hyperflexion injury (forced plantar flexion) also known as “sand toe” as this is common in sand volleyball players and skimboarders causing injury to the dorsal capsular structures
Turf toe injuries are graded from 1-3 in severity:
- grade 1 - stretch or minor tearing of the 1st MTP capsuloligamentous structures
- grade 2 - partial tearing of the capsuloligamentous structures with intact articular surface
- grade 3 - complete disruption of the capsuloligamentous structures with impaction deformity of the MTP, articular cartilage damage, trabecular edema, sesamoidal fracture, or diastasis of sesamoidal fragments
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