- Metatarsophalangeal (MTP) joint sprain
- 845.12 Sprain of metatarsophalangeal (joint) of foot
- S93.529A Sprain of metatarsophalangeal joint of unspecified toe(s), initial encounter
- 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)
- 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 severity5
- 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
- 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
- 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
- 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
- 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
Possible Contributing Causes
- Abnormal bone structure
- Dislocation of the MTP
- Hallux valgus
- Hallux rigidus
- Osteochondrotic lesion of the first metatarsal head
- Osteochondritis dissecans
- Metatarsal stress fracture
- Ligamentous laxity
- Levels of sprains5
- Corticosteroid injection
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