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Condition/Disorder Synonym

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  • Metatarsophalangeal (MTP) joint sprain

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ICD-9-CM Code1

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  • 845.12 Sprain of metatarsophalangeal (joint) of foot

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ICD-10-CM Code2

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  • S93.529A Sprain of metatarsophalangeal joint of unspecified toe(s), initial encounter

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Preferred Practice Pattern3

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Key Features

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Description4

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  • Sprain to the ligaments and capsule around the big (great) toe metatarsal phalangeal joint (MTP or MPJ)

  • Caused by a hyperextension or hyperflexion injury of the big toe, first MTP joint

  • Typically a sudden injury, common to fall (tackled) over a fixed foot overstretching the toe into hyperextension

  • Limited joint mobility at the MTP joint

  • Can involve the sesamoid bones (two small bones embedded in the flexor hallucis longus)

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Essentials of Diagnosis

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  • Diagnosis is usually made by clinical examination or x-ray

  • Can be an independent diagnosis and not associated with a disease process

  • Three grades of severity 5

    • Grade 1 sprain: minor stretch injury to the soft tissue restraints with little pain, swelling, or disability

    • Grade II sprain: partial tear of the capsuloligamentous structures with moderate pain, swelling, ecchymosis, and disability

    • Grade III: complete tear of the plantar plate with severe swelling, pain, ecchymosis, and an inability to bear weight normally

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General Considerations

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  • Pain and swelling

  • Inflammation around the first MTP joint

  • Will alter mechanics during the push-off phase of gait

  • If not managed properly, arthritis, spurring, and osteophytes can develop

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Demographics

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  • Commonly seen in athletes playing on artificial surfaces

  • Can happen on grass with shoes that do not adequately support the feet (such as soccer shoes)

  • Affects dancers, football players, and rugby players

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Clinical Findings

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Signs and Symptoms

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  • Pain at the base of the first toe

  • Starts suddenly as a result of injury

  • Pain in first metatarsal with walking

  • Decreased extension or flexion of the big toe

  • Joint redness and pain

  • Limited motion of the MTP joint due to pain

  • Weakness of toe flexion/extension

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Functional Implications

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  • Pain with standing and ambulation

  • Lack of push-off with toe and plantar flexion, reducing speed in running

  • Pain with ambulation at the toe

  • Alteration of gait pattern and mechanical issues of the forefoot can increase supination and external rotation of the foot for clearance, also forefoot abduction, lateral whip

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Possible Contributing Causes

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  • Abnormal bone structure

  • Trauma

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Differential Diagnosis

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  • Dislocation of the MTP

  • Hallux valgus

  • Sesamoiditis

  • Hallux rigidus

  • Gout

  • Osteochondrotic lesion of the first metatarsal head

  • Osteochondritis dissecans

  • Metatarsalgia

  • Metatarsal stress fracture

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Means of Confirmation or Diagnosis

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