Turf Toe & 1st MPJ

Question 1

What is turf toe?

Answer 1

hyperextension of 1st MPJ that causes tearing of plantar plate

Question 2

what is hyperflexion of 1st MPJ called?

Answer 2

sand toe

Question 3

Although ankle injury is 4x more common, turf toe accounts for more missed playing time.

Answer 3

true

Question 4

foot injuries are 3rd most common injury in athletes, behind knee and ankle injuries.

Answer 4

true

Question 5

When is turf toe seen?

Answer 5

(soccer or football player)

occurs when axial load is dellivered to a foot fixed in equinus

Question 6

What are some causative factors of turf toe?

Answer 6

• soft soled shoes

- synthetic surfaces that have a higher coefficient of friction and limited shock absorption

Question 7

Grade this: attenuation, swelling, minimal ecchymosis

Answer 7

grade 1 turf toe

Question 8

what is treatment for grade 1?

Answer 8

symptomatic, carbon fiber plate

*return to play as toelrated

Question 9

grade this: partial tear, moderate swelling, restricted motion due to pain

Answer 9

grade 2 turf toe

Question 10

how would you treat grade 2?

Answer 10

walking boot/ crutches as needed

*up to 2 weeks benched from play

Question 11

grade this: complete disruption, significant swelling/bruising, obvious instability, cartilage damage.

Answer 11

grade 3 turf toe

Question 12

how would you treat grade 3?

Answer 12

long term immobilization

or surgery

Question 13

when is surgical treatment for turf toe indicated?

Answer 13

if tear is present in soft tissues

Question 14

what is predislocation syndrome?

Answer 14

a spectrum of disorders that covers any pain or strain on lesser MPJ (most commonly 2nd MPJ)

Question 15

describe the attachments of plantar plate.

Answer 15

STRONGLY attached to base of proximal phalanx; LOOSELY attached to metatarsal head

Question 16

what happens with rupture of plantar plate?

Answer 16

• proximal phalanx moves dorsally

- extensor tendons cannot extend PIPJ and DIPJ

Question 17

what is the etiology of predislocation syndrome?

Answer 17

biomechanical defects- esp pronation due to equinus

*2nd MPJ affected usually

Question 18

stage this: mild plantar and dorsal edema

• extreme tenderness with palpation
• no clinical anatomic alignment

Answer 18

stage 1 predislocation syndrome-

Question 19

stage this: moderate edema; deviation of toe both clinically and radiographically (toe doesn’t touch ground)

Answer 19

stage 2 predislocation syndrome

Question 20

stage this : moderate edema about entire circumference of MPJ, edema extends into toe, pronounced deviation with possible dorsal dislocation

Answer 20

stage 3 predislocation syndrome

Question 21

treatment for predislocation syndrome?

Answer 21

conservative: shoe modifications, taping, off-loading, rest, ice
surgery is indicated when flexibility and reducibility of deformity are lost

Question 22

what accounts for more missed playing time? ankle injury or turf toe

Answer 22

turf toe

Question 23

what are some conservative treatment options for turf toe?

Answer 23

• orthotic
• stiff soled shoe
• taping
• offloading with crutches/boot
• NSAIDS to treat pain