Etiology and biomechanics of first metatarsophalangeal joint sprains (turf toe) in athletes.
ABSTRACT Sprains of the first metatarsophalangeal (MTP) joint, referred to colloquially as "turf toe," are a debilitating sports injury because the hallux is pivotal to an athletes' ability to accelerate and cut. Severe sprains may require weeks to full recovery, and injuries requiring surgery may prevent an athlete from full athletic participation for months. Whereas the diagnosis and treatment of turf toe are well documented in the literature, less is known about the biomechanics of this joint and the mechanical properties of the structures that compose it. Nevertheless, this information is vital to those, such as equipment designers, who attempt to develop athletic footwear and surfaces intended to reduce the likelihood of injury. To that end, this review summarizes the literature on the anatomy of the first MTP joint, on biomechanical studies of the first MTP joint, and on the incidence, mechanisms, and treatment of turf toe. Furthermore, gaps in the literature are identified and opportunities for future research are discussed. Only through a thorough synthesis of the anatomic, biomechanical, and clinical knowledge regarding first MTP joint sprains can appropriate countermeasures be designed to reduce the prevalence and severity of these injuries.
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ABSTRACT: Hallux rigidus describes the osteoarthritis of the first metatarsophalangeal joint. It was first mentioned in 1887. Since then a multitude of terms have been introduced referring to the same disease. The main complaints are pain especially during movement and a limited range of motion. Radiographically the typical signs of osteoarthritis can be observed starting at the dorsal portion of the joint. Numerous classifications make the comparison of the different studies difficult. If non-operative treatment fails to resolve the symptoms operative treatment is indicated. The most studied procedure with reproducible results is the arthrodesis. Nevertheless, many patients refuse this treatment option, favouring a procedure preserving motion. Different motion preserving and joint sacrificing operations such as arthroplasty are available. In this review we focus on motion and joint preserving procedures. Numerous joint preserving osteotomies have been described. Most of them try to relocate the viable plantar cartilage more dorsally, to decompress the joint and to increase dorsiflexion of the first metatarsal bone. Multiple studies are available investigating these procedures. Most of them suffer from low quality, short follow up and small patient numbers. Consequently the grade of recommendation is low. Nonetheless, joint preserving procedures are appealing because if they fail to relief the symptoms an arthrodesis or arthroplasty can still be performed thereafter.World journal of orthopedics. 01/2014; 5(1):6-13.
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ABSTRACT: INTRODUCTION: Sprains of the first metatarsophalangeal (1MTP) joint, also known as turf toe, are debilitating athletic injuries. Since 85% of 1MTP sprains result from excessive hallux dorsiflexion, interventions which limit motion to sub-injurious levels would greatly benefit athletes. Hallux dorsiflexion range of motion (hdROM) cannot be overly constrained, however, lest athletic performance be compromised. Therefore, the tolerance of the 1MTP joint to excessive dorsiflexion injury must be quantified before appropriate hdROM limitations may be developed. The purpose of this study is to develop a quantitative injury risk function for 1MTP sprains based on hallux dorsiflexion angle. METHODS: Twenty cadaveric limbs were tested to both sub-injurious and injurious levels of hallux dorsiflexion. Motion-capture techniques were used to track six degree-of-freedom motion of the first proximal phalanx, first metatarsal, and calcaneus. Specimens were examined by physicians post-test to diagnose injury occurrence and ensure clinical relevance of the injuries. RESULTS: A two-parameter Weibull hazard function analysis reveals that a 50% risk of injury occurs at 78º of dorsiflexion from anatomical zero. CONCLUSION: Methods presented here drove cadaver 1MTP joints to various degrees of dorsiflexion, resulting in both non-injurious and injurious trials which were formed into an injury risk function.Medicine and science in sports and exercise 05/2013; · 4.48 Impact Factor