Inside Insights For Tackling Football Injuries

By Mark A. Caselli, DPM

How To Manage First MPJ Injuries

   Turf toe is a condition that involves injury to the first metatarsophalangeal joint (MPJ) complex. The use of lightweight, flexible shoes on hard artificial turf reportedly increases the frequency of this injury. In one study, 83 percent of the patients reported that their initial injury occurred on artificial turf. The usual mechanism is forced dorsiflexion of the first MPJ joint, which causes stretching of the plantar structures and impaction of the proximal phalanx on the dorsal metatarsal. This often occurs when a player falls on the posterior aspect of another player’s leg. Pain during push-off, swelling, decreased motion and tenderness at the dorsal or plantar aspect of the joint are typical symptoms with these injuries.    One should evaluate radiographs to rule out associated fractures, including fractures of the sesamoids. One would grade injuries to this complex according to their severity. Grade I injuries are marked by local tenderness without swelling or ecchymosis. Grade II injuries have swelling and ecchymosis, and tenderness may be less well localized. Grade III sprains have more marked tenderness, primarily dorsally, and probably represent a spontaneously reduced first MPJ dislocation. The initial treatment for all grades of turf toe is rest, ice, compression dressings, elevation and nonsteroidal antiinflammatory drugs (NSAIDs).    One can usually treat grade I injuries effectively with conservative measures. Athletes may continue sports activity if they wear stiff-soled shoes to reduce dorsiflexion during the push-off phase. They should also tape the great toe by bringing the tape from the dorsal surface of the great toe to the plantar surface. This also limits the amount of dorsiflexion.    Athletes with grade II injuries should refrain from sports activities for one to two weeks and wear stiff-soled shoes. Athletes can insert a rigid orthosis to further prevent dorsiflexion of the first MPJ. Grade III injuries require the same modalities as grade II injuries but the restriction of athletic activities should be three to six weeks. If these conservative measures fail for grade III injuries, surgery for plantar capsular repair or loose body removal may be necessary.

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