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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


  • 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)

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 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

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


  • 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

Signs and Symptoms

  • 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

Functional Implications

  • 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
  • Trauma

Differential Diagnosis

  • Dislocation of the MTP
  • Hallux valgus
  • Sesamoiditis
  • Hallux rigidus
  • Gout
  • Osteochondrotic lesion of the first metatarsal head
  • Osteochondritis dissecans
  • Metatarsalgia
  • Metatarsal stress fracture


  • X-ray
  • Bone scan
  • CT scan
  • MRI

  • Edema
  • Ligamentous laxity
  • Levels of sprains5


  • Anti-inflammatory
  • Corticosteroid injection

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