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  • Metatarsophalangeal (MTP) joint sprain


  • 845.12 Sprain of metatarsophalangeal (joint) of foot


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


  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation


A 20-year-old football player hyperextended the great toe while playing on synthetic turf grass. He thinks his cleat may have gotten stuck in the turf while being tackled. The patient has a painful and swollen MTP joint of the great toe. He cannot walk or run without pain. Patient states the toe hurts the most when he tries to push-off with the toe/foot. The patient has a turf toe orthotic in his shoe.



  • Sprain to the ligaments and capsule around the big (great) toe metatarsophalangeal joint (MTP or MTPJ)

  • 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 brevis)

Essentials of Diagnosis

  • 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 classification5

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

    • Grade 2 sprain: Partial tear of the capsuloligamentous structures with moderate pain, swelling, ecchymosis, and disability

    • Grade 3: Complete tear of the plantar plate with severe swelling, pain, ecchymosis, and an inability to bear weight normally

FIGURE 214-1

Metatarsophalangeal dislocations. (From Simon RR, Sherman SC. Emergency Orthopedics, 6th ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

General Considerations

  • 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

FIGURE 214-2

Sesamoid fractures. (From Simon RR, Sherman SC. Emergency Orthopedics. 6th ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)


  • Commonly seen in athletes playing on artificial surfaces

  • Can happen on grass with a shoe that does not adequately support the foot (such as soccer shoes)

  • Dancers, football players, rugby players



  • Pain at ...

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