Citation, DOI, disclosures and article data
At the time the article was created Imran Jindani had no recorded disclosures.View Imran Jindani's current disclosures
At the time the article was last revised Sajanakan Sriselvakumar had no financial relationships to ineligible companies to disclose.View Sajanakan Sriselvakumar's current disclosures
Turf toe refers to a sprain, partial tear, or complete tear of the first metatarsophalangeal (MTP) plantar plate 5.
On this page:
Plantar plate tears can be broadly divided into involving the 1st toe/ hallux/great toe and termed turf toe or sand toe, or the lesser metatarsals/toes 2 - 5, and termed plantar plate tears 5.
Originally described in American football players, it is common in professional athletes, especially on artificial surfaces, and is not particular to a specific sport. It 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 superimposed varus or valgus angulation, which causes disruption of the plantar plate capsuloligamentous complex and allows unrestricted range of motion of the first 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
dynamic maneuvers with ultrasound can demonstrate discontinuity of the normal plantar plate
following acute trauma, focal edema in an aspect of a plantar plate suggests low-grade sprain or tear, without discontinuity 5
persistent hyper-extension of the proximal phalanx, or valgus/varus deviation of the toe
Indirect features of a plantar plate injury
metatarsophalangeal joint synovitis
flexor tendon sheath tenosynovitis
Most turf toe injuries can be managed with rest, ice and elevation. Stiff-sole shoe or walking boot can be used as part of non-operative treatment modality. Surgical repair is reserved for severe cases that do that respond to conservative treatment options.
- 1. Stoller D, Tirman P, Bredella M et-al. Diagnostic imaging. AMIRSYS. (2004) ISBN:0721629202. Read it at Google Books - Find it at Amazon
- 2. Allen LR, Flemming D, Sanders TG. Turf toe: ligamentous injury of the first metatarsophalangeal joint. Mil Med. 2005;169 (11): xix-xxiv. Pubmed citation
- 3. Wilson L, Dimeff R, Miniaci A et-al. Radiologic case study. First metarsophalangeal plantar plate injury (turf toe). Orthopedics. 2005;28 (4): 344, 417-9. Pubmed citation
- 4. Ashman CJ, Klecker RJ, Yu JS. Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. Radiographics. 2001;21 (6): 1425-40. Radiographics (full text) - Pubmed citation
- 5. William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip Robinson, Christian W.A. Pfirrmann. Glossary of terms for musculoskeletal radiology. (2020) Skeletal Radiology. doi:10.1007/s00256-020-03465-1 - Pubmed
- 6. Hallinan J, Statum S, Huang B et al. High-Resolution MRI of the First Metatarsophalangeal Joint: Gross Anatomy and Injury Characterization. Radiographics. 2020;40(4):1107-24. doi:10.1148/rg.2020190145 - Pubmed
- 7. York P, Wydra F, Hunt K. Injuries to the Great Toe. Curr Rev Musculoskelet Med. 2017;10(1):104-12. doi:10.1007/s12178-017-9390-y - Pubmed