Dr. Ebraheim's educational animation video describing the condition of Turf Toe. Injury of the plantar plate sesamoid complex.Turf Toe Causes, Symptoms, Treatment .turf toe tapping ,massage rehab and turf toe exercises and turf toe surgery .turf toe treatment big toe pain .big toe arthritis, hallux rigidus exercises , tapping , therapy and surgery.
It is a hyperextension, dorsiflexion injury of the big toe’s first MTP joint.
This injury tears the insertion of the planter plate from the proximal phalanx which leads to incompetent sesamoid complex.
It is seen more in contact sports when they play on rigid surfaces, the big toe, MTR joint is positioned in hyperextension and the forefoot is fixed to the ground, and with axial load to the heel, the planter plate sesamoid complex tears.
The sesamoid can fracture or proximally migrate.
You may have an occult fracture of the proximal phalanx.
When you classify these injuries, they can be either a sprain, a partial tear, or a complete tear.
Injuries:
There are many factors implicated with an increased incidence of turf toe.
Increased hardness of the artificial turf
Increased shoe flexibility
Factors associated with the patient:
Weight of the athlete/ patient.
Age
Type of sport being played
Factors associated with the foot itself.
Turf toe is seen in a lot of different sports, but more common with football players.
Clinical picture:
The patient will present with pain, swelling, and inability to “push off” with the big toe.
The patient will have planter swelling, tenderness, and ecchymosis.
The vertical lachman’s test is positive.
Varus and valgus instability is present; always compare the injured foot to the other side.
Get an xray.
Either fracture or proximal migration of the sesamoid bone will be seen.
If seen on an AP view xray, this means that there is complete rupture of the planter plate.
The sesamoid bone will not move under fluoroscopy with range of motion of the first MTP joint.
Treatment:
These injuries have the potential to become a chronic problem.
Hallux valgus, hallux rigidus.
Most of the athletes and coaches perceive this injury as a small, trivial injury.
Most athletes return to sports without sufficient time for healing and recovery.
Approximately 50% of these patients will complain of persistent symptoms, such as stiffness of the big toe or hallux valgus deformity after more than five years after the injury occurred.
This will lead to chronic disability and prevent the athlete from competing.
Most of these injuries can be treated conservatively:
• Ice
• Rest
• Taping
• Orthotics, rigid morton’s extension.
More severe cases:
• Boot or cast for a few weeks then therapy for motion.
• Surgery for repair is rare
• Surgery is done if there is failure of conservative treatment, or if there is grade III tear, which is a complete tear of the plate.
• So you will repair the planter plate to the proximal phalanx through a planter approach.
• The sesamoid bone may be excised partially or completely if it is fractured.
• Return to play is usually about 34 months after surgery.
What is the Late Sequelae: it is hallux rigidus which may need rigid morton’s extension or surgery (cheilectomy).


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