Sesamoid and Capsule Lesions of the First Metatarsophalangeal Joint

Abstract

Turf toe is a hyperextension injury to the hallux metatarsophalangeal (MTP) joint that commonly occurs during athletics when an axial load is delivered to the heel with the ankle in plantarflexion and the hallux in dorsiflexion or extension. Hyperextension at the hallux MTP joint can lead to tearing and/or attenuation of the plantar capsuloligamentous structures, which in turn may lead to joint instability, pain, and decreased function. The incidence of turf toe has risen over the past four decades as awareness of the injury has grown along with advances in surgical management and rehabilitation. A thorough history and clinical exam focusing on hallux MTP stability and flexion strength is critical to ensure a timely diagnosis. Proximal migration of the sesamoids should be carefully examined on standard radiographs, dynamic stress views, and MRI. Management of turf toe injuries depends on the grade of the injury, with surgical intervention recommended in cases of complete disruption of the plantar structures with persistent joint instability and pain despite non-operative treatments. Direct repair of the plantar capsuloligamentous complex can be successfully achieved using a two-incision approach (medial and plantar). Post-operative rehabilitation is critical to final outcome and return to athletics is permitted 3–4 months after surgery depending on sport and position played.