In some of the world’s greatest sports such as football, soccer, basketball, etc., injuries are the topic of conversation. How many weeks will the franchise athlete miss with an Achilles tear, knee sprain, Tommy John surgery, or broken bone? However, an injury to the metatarsophalangeal joint, commonly known as Turf Toe, can cause an athlete severe pain leaving star players sidelined for prolonged periods of time. While the increased flexion at the connection between the great or big toe and the bottom of the foot will continue to be present in every high-level sport, understanding the mechanics surrounding this injury might help remediate and treat this pain in the future.
Sesamoids
There are many mechanical forces present during extension of the foot and force provided to the big toe. While the metatarsal joint, the connection between toe and remainder of the foot, receives a majority of the strain, the displacement of a very small bone on the bottom of the foot known as the sesamoid can lead to the foot pain common in long term injuries. A particular study addressed in the article from French et al., studied the displacement of this sesamoid bone in 10 frozen feet. This study proves that as the extension of the big toe increases, the increased strain between the toe and foot causes greater sesamoid displacement and pain. Furthermore, depending on the rotation angle of the tendons present in the metatarsal joint, the sesamoid can have differing and just as harmful displacements in the tibial and fibular direction as seen in the image below.
Mechanics & Treatment
The mechanics behind a “Turf Toe” injury involve the first metatarsophalangeal joint. This joint is a combination of the many joints and tissue that attach the great toe to the remainder of the foot structure. The severity of the stress found in the foot which therefore causes strain in the MTP joint as well as sesamoid displacement as discussed earlier can determine the severity of the injury as well as necessary time for rest. In this particular study addressed by Waldrop et al., 24 frozen feet were tested at varying forces and strains applied. As expected, an increased strain leads to further sesamoid displacement and greater severity of injury. In extreme cases, as that strain increases, a tear of the brevis tendon and tibial ligament referenced in the image below would cause surgery and extended time for rest.
“Turf Toe” has become a hot topic amongst many professional sports due to the long recovery and rehabilitation time for a rather unknown and seemingly unimportant injury. While this injury, like most, is not preventable, once symptoms arise, load and pain management can help prevent further damage and absences approaching 6 to 8 weeks. For instance, Joe Burrow, the starting quarterback for the Cincinnati Bengals, suffered a grade 3 injury that will leave him sidelined for a majority of the NFL season. Therefore, if the tear of the tendons surrounding the metatarsal joint are severe enough that the plantar plate is disrupted, the rehabilitation for the injury will cause increased rest with surgery in extreme cases.
While this is a brief and surface level introduction to the mechanics surrounding an injury of the metatarsal joint, understanding the mechanics present in this subsystem can help guide treatment and training. Professional athletes and their affiliated sports franchises require continued guidance, innovation, and creativity for treating this “Turf Toe” injury that affects many. If you are interested in reading more about this injury, click here.
Featured image from Pixaby License.