synonyms:first metatarsophalangeal joint sprain, 1st MTP sprain, 

Turf Toe ICD-10

• S93.521A - Sprain of metatarsophalangeal joint of right great toe, initial encounter
• S93.522A - Sprain of metatarsophalangeal joint of left great toe, initial encounter
• S93.523A - Sprain of metatarsophalangeal joint of unspecified great toe, initial encounter
• See all Sprain Great toe metatarsophalangeal ICD-10 

A- initial encounter

D- subsequent encounter

S- sequela

Turf Toe ICD-9

• 845.12  Sprains and strains of metatarsophalangeal joint

Turf Toe Etiology / Epidemiology / Natural History

• Hyperextension injury to the first metatarsophalangeal joint
• Sprain of the capsuloligamentous complex of the first MTP joint.
• Generaly due to a forced hyperextension injury.
• Commonly occurs in American football. 45% of NFL players have experienced turf toe with 83% occuring on older versions of artificial turf. (Rodeo SA,  Am J Sports Med 1990;18(3):280)
• May account for more missed playing time than ankle sprains. 

Turf Toe Anatomy

• hyperextension injury causes rupture of the plantar capsuloligamentous structures 

Turf Toe Clinical Evaluation

• Pain in the great toe MTP joint.  Pain is exacerbated by MTP extension.
• Decreased push-off strength.
• Evaluate hallus MTP stability and flexion strength.

Turf Toe Xray / Diagnositc Tests

• AP, lateral and oblique views of the foot and great toe are generally normal. Evaluate for sesamoid fracture or diastasis of bipartite sesamoid.  Proximal migration of the sesamoids indicates capsular rupture
• MRI: best demonstrates plantar capsuloligamentous integrity. Also indicated if sesamoid, metatarsal or proximal phalanx stress fracture is a concern.  

Turf Toe Classification / Treatment

• Rigid forefoot insole to stiffen athletic shoes (turfliner half steel), PT modialities (ice), NSAIDs
• Grade I: attenuation of plantar structures: localized swelling, minimal ecchymosis. Treatment = rest, ice, compression and elevation (RICE).  Stiff soled or rocker bottom shoes are beneficial.  Taping and early rehabilitation (eg, range-of-motion exercises, gradual strengthening), return to play as tolerated. Consider turf-toe plate or carbon-fiber orthosis to limit hallux MTP extension.
• Grade II:partial tear of plantar structures: moderate swelling, and restricted motion due to pain.  Treatment =  rest, ice, compression and elevation (RICE).  Stiff soled or rocker bottom shoes are beneficial. Taping and early rehabilitation (eg, range-of-motion exercises, gradual strengthening), return to play generally takes 2-3 weeks. Consider turf-toe plate or carbon-fiber orthosis to limit hallux MTP extension.
• Grade III: complete disruption of plantar structures: significant swelling and ecchymosis, hallux flexion weakness, may have frank instability of the MTP joint. Treatment=  rest, ice, compression and elevation (RICE).  Immobilization in plantar flexion to allow the plantar structures to oppose and heal for 2-3 weeks.  Stiff soled or rocker bottom shoes for 4-6 weeks.  Generally can return to play at 6 weeks.  Consider open repair of the ruptured capsuloligamentous complex (Anderson R: Turf toe injuries of the hallux metatarsophalangeal joint. Techniques in Foot & Ankle Surgery 2002;1:102-111)

Turf Toe Associated Injuries / Differential Diagnosis

• Hallux rigidus
• Hallux sesamoid fracture
• Proximal phalanx stress fracture
• 1st metacarpal stress fracture

Turf Toe Complications

• Chronic pain
• Hallux rigidus

Turf Toe Follow-up Care

• Following surgical repair:  return to play = 6 to 12 months.
• Long term outcome:  can lead to Hallux rigidus. May develop acquired hallux valgus or hallux varus.  

Turf Toe Review References

• Anderson, RB, JAAOS 2010, 18:546
• Bowers KD Jr, Martin RB: Turf-toe: A shoe-surface related football injury. Med Sci Sports 1976;8(2):81-83. 
• Rodeo SA, O’Brien S, Warren RF, Barnes R, Wickiewicz TL, Dillingham MF: Turf-toe: An analysis of metatarsophalangeal joint sprains in professional football players. Am J Sports Med 1990;18(3):280-285.  
• McCormick JJ, Anderson RB: The great toe: Failed turf toe, chronic turf toe, and complicated sesamoid injuries. Foot Ankle Clin 2009;14(2):135-150.  
• Anderson R: Turf toe injuries of the hallux metatarsophalangeal joint. Techniques in Foot & Ankle Surgery 2002;1:102-111
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