Turf Toe Clinical Presentation

Updated: Jun 13, 2016
  • Author: Blake L Ohlson, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Presentation

History

Taking a detailed history is the first step in the treatment of all turf toe injuries. The clinician should determine the specific series of events leading to the injury.

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Physical Examination

Physical examination then follows, with attention to the presence and location of pain, swelling, and ecchymosis. The examination may be difficult in the acute stages because of pain; however, all structures, including the collateral ligaments, sesamoids, plantar plate, and dorsal capsule, should be palpated.

Range-of-motion (ROM) testing should be performed by carefully looking for instability, mechanical block, or hypermobility that may suggest tearing of the plantar plate. Instability is assessed by performing the varus or valgus stress test and the dorsoplantar drawer test of the metatarsophalangeal (MTP) joint.

A positive result with the former test suggests collateral ligament damage, whereas a positive finding with the latter suggests a plantar capsuloligamentous tear. Incidentally, the dorsoplantar test is performed with the MTP joint in 30º of dorsiflexion. Finally, examination of all structures is aided by comparison to the contralateral side.

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Classification

Injuries are graded as follows:

  • Grade 1 injury - Localized tenderness with minimal swelling and no ecchymosis
  • Grade 2 injury - More widespread tenderness with mild-to-moderate swelling and ecchymosis
  • Grade 3 injury - Severe and diffuse tenderness and swelling, moderate to severe ecchymosis, and painful ROM

Although most cases are managed conservatively, the treating physician should be alert to the presence of hallux malalignment, traumatic bunion deformity, diminished flexor strength, clawing of the great toe, generalized synovitis, or advanced degenerative joint disease. Clinical findings such as these often indicate that surgical intervention is required.

Table 1 below shows the classification scheme for tears of the capsuloligamentous complex, including for hyperflexion and dorsiflexion injuries.

Table 1. Classification Scheme for Tears of Capsuloligamentous Complex (Open Table in a new window)

Grade Resultant Injury Associated Injury
1 Stretch injury or minor tearing of the capsuloligamentous complex of the first MTP joint None
2 Partial tear of the capsuloligamentous complex of the first MTP joint without involvement of the articular surface None
3 Complete tear of the capsuloligamentous complex; tearing of the plantar plate from its origin on the metatarsal head/neck with dorsal impaction of the proximal phalanx into the metatarsal head Articular cartilage/subchondral bone bruise, sesamoid fracture, diastasis of the sesamoids, medial/lateral injury
Hyperflexion Hyperflexion injury to the hallux MTP joint with possible concomitant injury to lesser MTP joints Sprain or tearing of the dorsal capsule
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