Turf toe

Capsulitis of the 1st Metatarsophalangeal joint (MTPJ), commonly know as “turf toe”, is an injury to the joint capsule and the surrounding ligaments of the big toe joint. This can range from a small tear in the capsule, a full tear of the plantar plate, or even dislocation of the joint.

This condition arises most often from bending the toe too far backwards (hyperextension of the hallux at the 1st MTPJ). The joint capsule can become inflammed due to repeated trauma, and if the trauma is severe enough, can lead to sprains or tears as previously mentioned.

This condition commonly affects footballers, especially those playing on “grippy” surfaces such as Astroturf, martial artists, basketball players, people who practice ballet, sprinters, and other sports and forms of exercise, such as step aerobics. The force of the ball striking the 1st MTPJ during football is also a common cause.

Pain occurs locally within the 1st MTPJ and is worse for activity, reducing to a dull ache at rest, often accompanied by swelling, redness and pain on pressure (palpation). The pain will also be aggravated by bending the toe upward (dorsiflexion). Ultrasound and MRI can be used to confirm the diagnosis, although this is not always necessary. Other possible causes of pain in the 1st MTPJ should also be considered, including gout, osteoarthritis, or sesamoiditis.

Treatment for this condition is largely similar to that of osteoarthritis of the 1st MTPJ. During the acute stage, protection, rest, ice, compression, and elevation (PRICE) along with non-steroidal anti-inflammatory drugs (NSAIDs), both oral or topical, and other oral analgesics can be used. Medical-grade foot orthoses can also be prescribed for long term management. Acupuncture can also be helpful at managing pain, although needling the inflamed area during the acute phase is not recommended, so points nearby and distally will often be used in early stages of treatment.

In conditions where conservative methods fail to bring relief, it may be necessary to consider surgery.

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