Jeremy J. McCormick

Hallux rigidus is a term used to describe painful, limited motion and localized arthritis at the hallux metatarsophalangeal (MTP) joint. With early hallux rigidus, a dorsal cheilectomy can decrease pain and improve motion. With later stage disease, a hallux MTP arthrodesis is commonly chosen to decrease pain, sacrificing motion by fusing the hallux MTP joint. We present an alternative technique to arthrodesis for late stage hallux rigidus—the modified oblique Keller capsular interposition arthroplasty (MOKCIA). With this operation, the dorsal capsule of the hallux MTP joint is interposed into the joint, offering pain relief without sacrificing range of motion. Level of Evidence: Level V, expert opinion.

“Turf toe” is primarily a hyperextension injury to the hallux metatarsophalangeal (MTP) joint. It classically occurs in football players participating on artificial grass; however, it can occur in any sport, and on any surface. As turf toe is becoming more readily recognized and understood by physicians and trainers caring for athletes, we are able to identify the injury more acutely and treat it more efficiently. Through careful evaluation, we are also able to more accurately assess which patients will need surgical intervention to improve outcome. In this techniques paper, we review the entity of turf toe in the athlete with an acute injury. We also review the athlete who has experienced a “sprain” of the hallux MTP joint, yet continues to have symptoms necessitating surgical intervention. By reviewing the anatomy of the hallux MTP joint and our approach to the clinical and radiographic evaluation of the hallux MTP joint, we hope to offer guidance to treating the athlete with a turf toe injury, and, when indicated, a surgical technique for the operative repair of turf toe injury.

Background: As clinical suspicion increases and radiographic evaluation improves, navicular stress fractures are becoming a more recognized injury. To date, there is a small volume of literature examining these stress fractures, particularly as it pertains to outcomes of surgical management.

Context: Despite an increasing awareness of turf toe injury, confusion still exists regarding the anatomy, mechanism, diagnosis, and treatment of this hyperextension injury to the hallux metatarsophalangeal (MTP) joint. Evidence Acquisition: This article reviews the anatomy, diagnosis, and treatment algorithm for turf toe injury by reviewing relevant studies and presenting information useful to clinicians, therapists, and athletic trainers. A literature search was performed by a review of PubMed and OVID articles published from 1976 to July 2010. Results: Grade I injury is a sprain or attenuation of the plantar capsular ligamentous complex of the hallux MTP joint; athletes are typically able to return to play as tolerated. Grade II injury is a partial rupture of the plantar soft tissue structures of the hallux MTP joint, typically requiring about 2 weeks to recover. Grade III injury is a complete rupture of the plantar structures of the hallux MTP joint, requiring at least 10 to 16 weeks to recover. Some complete ruptures require surgical repair. Conclusion: With accurate diagnosis, athletes can have an appropriate treatment plan, and their expectations can be tempered to the degree of injury. Careful management may allow successful return to play at a preinjury level of participation.