Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Turf Toe

SYMPTOMS

There is a gradually increasing stiffness and diffuse aching pain around MTP I. Commonly affects team sports players who wear studded shoes.

AETIOLOGY

Common theories include repetitive minor trauma to the capsule and cartilage of MTP I from ill-fitting shoes, direct impact and playing on hard turf with shoes that get stuck. The name refers to an injury that dramatically increased in frequency when new artifical turf on all-weather football pitches became common.

CLINICAL FINDINGS

There is tenderness on palpation, swelling, effusion and redness over MTP I. Decreased active and passive flexion and extension of MTP I.

INVESTIGATIONS

X-ray is often normal in early stages but can later show bony intra-articular fragments. MRI may show effusion, oedema and swelling around MTP I.

TREATMENT

Initially try orthotics and stretching of the structures around MTP I. NSAID or local cortisone injections can give short-term relief.

REFERRALS

Refer to podiatrist and physiotherapist for mild symptoms and to orthopaedic foot surgeon if symptoms become severe. Surgery can be carried out, arthroscopically, to remove loose intra-articular bodies and debride the joint.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities, using well fitting shoes and avoiding impact. If there is painon impact suggest low-impact activities such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor the decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Stress fracture of sesam bones below MTP I (X-ray or MRI can differentiate); Hallux rigidus (X-ray and clinical picture differentiate).

PROGNOSIS

Excellent-Good but there can be long duration of symptoms.

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