Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ 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 +++ Description4 ++ 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 jointTypically a sudden injury, common to fall (tackled) over a fixed foot overstretching the toe into hyperextensionLimited joint mobility at the MTP jointCan involve the sesamoid bones (two small bones embedded in the flexor hallucis longus) +++ Essentials of Diagnosis ++ Diagnosis is usually made by clinical examination or x-rayCan be an independent diagnosis and not associated with a disease processThree grades of severity5Grade 1 sprain: minor stretch injury to the soft tissue restraints with little pain, swelling, or disabilityGrade II sprain: partial tear of the capsuloligamentous structures with moderate pain, swelling, ecchymosis, and disabilityGrade III: complete tear of the plantar plate with severe swelling, pain, ecchymosis, and an inability to bear weight normally +++ General Considerations ++ Pain and swellingInflammation around the first MTP jointWill alter mechanics during the push-off phase of gaitIf not managed properly, arthritis, spurring, and osteophytes can develop +++ Demographics ++ Commonly seen in athletes playing on artificial surfacesCan happen on grass with shoes that do not adequately support the feet (such as soccer shoes)Affects dancers, football players, and rugby players +++ Signs and Symptoms ++ Pain at the base of the first toeStarts suddenly as a result of injuryPain in first metatarsal with walkingDecreased extension or flexion of the big toeJoint redness and painLimited motion of the MTP joint due to painWeakness of toe flexion/extension +++ Functional Implications ++ Pain with standing and ambulationLack of push-off with toe and plantar flexion, reducing speed in runningPain with ambulation at the toeAlteration 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 structureTrauma +++ Differential Diagnosis ++ Dislocation of the MTPHallux valgusSesamoiditisHallux rigidusGoutOsteochondrotic lesion of the first metatarsal headOsteochondritis dissecansMetatarsalgiaMetatarsal stress fracture +++ Imaging ++ X-rayBone scanCT scanMRI ++ EdemaLigamentous laxityLevels of sprains5 +++ Medication ++ Anti-inflammatoryCorticosteroid injection +++... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.