At time of review, only clinical commentaries (1-5) were included as no clinical trials were found. Reference 5 was not summarized due to overlapping content, but remains on the reference list as a resource for other types of sesamoid injuries.
Turf toe is an injury to plantar capsular ligamentous structures of metatarsophalangeal (MTP) joint caused by excessive great toe extension (1-4). A common injury mechanism occurs in football when foot is fixed in equinus and an axial load forces MTP joint into hyperextension (4).
Artificial turf was introduced in 1965, and turf toe was first described in literature in 1976 with reported 5.4 injuries per yr among team of collegiate players (2-4). A 1990 study of 80 NFL players found that 45% experienced turf toe injuries with 80% of injuries occurring on artificial surfaces (2-4). In contrast, a 2004 study reported similar rates of injury among high school football players regardless of type of playing surface (4). A recent increase in incidence of turf toe points to more flexible footwear as possible factor (4).
Conservative treatment should include initial period of rest, ice, compression, and elevation (RICE), anti inflammatories, early passive ROM, exercise to strengthen great toe flexors and extensors, and gradual return to activity according to pain (1-4). Use of taping, stiff soled shoes, forefoot inserts, or an insole with Morton's extension is recommended to minimize toe extension during activity (2-4). Treatment by injury grade is described by Coughlin (2) and McCormick and Naderson (3, 4). While grade I injury may not need any time away from activities, grades III/IV may require several mos of recovery and/or surgery (2-4).
Conservative management of turf toe is initially recommended, with operative management typically reserved for those that meet specific criteria (e.g., capsular avulsion, sesamoid retraction) or when conservative care fails. Sample exercises from VHI PC-Kits have been provided based on recommendations from reviewed articles.
Dr. Joshua M. Brooks
Chiropractor, Falls Church VA 22046
No comments:
Post a Comment