Etiology and biomechanics of first metatarsophalangeal joint sprains (turf toe) in athletes.

Center for Applied Biomechanics, University of Virginia, Charlottesville, VA 22911, USA.
Critical Reviews in Biomedical Engineering 01/2012; 40(1):43-61.
Source: PubMed

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: 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 78ยบ 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.
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