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Injuries to the great toe


Purpose of review

Injuries to the great toe are common in athletes. While most are managed nonoperatively and allow return to sports activity, some great toe injuries are highly problematic and can impact function. The purpose of this review is to highlight several specific injuries and disease processes involving the hallux and to detail current recommendations and management options in order to help raise suspicion for injuries that can result in long-term dysfunction.

Recent findings

Toe injuries have been found to represent nearly 10% of injuries presenting to fracture clinics. While most injuries can be treated nonsurgically, there are a number of specific injuries that require a high index of suspicion, careful management, and in some cases, surgical intervention. Injuries detailed in this review include turf toe, traumatic bunion, and hallux and sesamoid fractures. Additional pathologies that are covered include sesamoiditis and sesamoid avascular necrosis as well as hallux rigidus. Appropriate workup and current treatment recommendations are discussed.


Injuries to the hallux can result in long-term pain and disability if not properly diagnosed and treated. A high index of suspicion is required.

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  1. Mason LW, Molloy AP. Turf toe and disorders of the sesamoid complex. Clin Sports Med. 2015;34:725–39. doi:10.1016/j.csm.2015.06.008.

    Article  PubMed  Google Scholar 

  2. Vaseenon T, Phisitkul P. Arthroscopic debridement for first metatarsophalangeal joint arthrodesis with a 2- versus 3-portal technique: a cadaveric study. Arthrosc—J Arthrosc Relat Surg. 2010;26:1363–7. doi:10.1016/j.arthro.2010.02.015.

    Article  Google Scholar 

  3. McBride ID, Wyss UP, Cooke TD, et al. First metatarsophalangeal joint reaction forces during high-heel gait. Foot Ankle. 1991;11:282–8. doi:10.1177/107110079101100505.

    Article  CAS  PubMed  Google Scholar 

  4. Bowers KD, Martin RB. Turf-toe: a shoe-surface related football injury. Med Sci Sports. 1976;8:81–3.

    PubMed  Google Scholar 

  5. Watson TS, Anderson RB, Davis WH. Periarticular injuries to the hallux metatarsophalangeal joint in athletes. Foot Ankle Clin. 2000;5:687–713.

    CAS  PubMed  Google Scholar 

  6. George E, Harris AHS, Dragoo JL, Hunt KJ. Incidence and risk factors for turf toe injuries in intercollegiate football: data from the National Collegiate Athletic Association Injury Surveillance System. Foot Ankle Int. 2014;35:108–15. doi:10.1177/1071100713514038.

    Article  PubMed  Google Scholar 

  7. Frimenko RE, Lievers WB, Riley PO, et al. Development of an injury risk function for first metatarsophalangeal joint sprains. Med Sci Sports Exerc. 2013;45:2144–50. doi:10.1249/MSS.0b013e3182994a10.

    Article  PubMed  Google Scholar 

  8. Waldrop NE, Zirker CA, Wijdicks CA, et al. Radiographic evaluation of plantar plate injury: an in vitro biomechanical study. Foot ankle Int. 2013;34:403–8. doi:10.1177/1071100712464953.

    Article  PubMed  Google Scholar 

  9. Roche AJ, Calder JD. An atraumatic turf toe in an elite soccer player—a stress related phenomenon? Foot Ankle Surg. 2014;20:71–3. doi:10.1016/j.fas.2013.09.003.

    Article  PubMed  Google Scholar 

  10. Rodeo SA, Warren RF, O’Brien SJ, et al. Diastasis of bipartite sesamoids of the first metatarsophalangeal joint. Foot Ankle. 1993;14:425–34.

    Article  CAS  PubMed  Google Scholar 

  11. Hsu AR, Anderson RB. Foot and ankle injuries in American football. Am J Orthop (Belle Mead NJ). 2016;45:358–67.

    Google Scholar 

  12. Dietrich TJ, da Silva FLF, de Abreu MR, et al. First metatarsophalangeal joint- MRI findings in asymptomatic volunteers. Eur Radiol. 2015;25:970–9. doi:10.1007/s00330-014-3489-y.

    Article  PubMed  Google Scholar 

  13. Anderson RB. Turf toe injuries of the hallux metatarsophalangeal joint. Tech Foot Ankle Surg. 2002;1:102–11.

    Article  Google Scholar 

  14. McCormick JJ, Anderson RB. Turf toe: anatomy, diagnosis, and treatment. Sport Heal A Multidiscip Approach. 2010;2:487–94. doi:10.1177/1941738110386681.

    Article  Google Scholar 

  15. Doty J, Coughlin M. Turf toe repair. A technical note. Foot Ankle Spec. 2015;6:452–6. doi:10.1177/1938640013507107.

    Article  Google Scholar 

  16. Jahss MH. The sesamoids of the hallux. Clin Orthop Relat Res. (1981); 88–97.

  17. Dedmond BT, Cory JW, McBryde A. The hallucal sesamoid complex. J Am Acad Orthop Surg. 2006;14:745–53.

    Article  PubMed  Google Scholar 

  18. Anderson RB, McBryde Jr AM. Autogenous bone grafting of hallux sesamoid nonunions. Foot Ankle Int. 1997;18:293–6. doi:10.1177/107110079701800509.

    Article  CAS  PubMed  Google Scholar 

  19. Blundell CM, Nicholson P, Blackney MW. Percutaneous screw fixation for fractures of the sesamoid bones of the hallux. J Bone Joint Surg Br. 2002;84:1138–41. doi:10.1302/0301-620X.84B8.13064.

    Article  CAS  PubMed  Google Scholar 

  20. Pagenstert GI, Valderrabano V, Hintermann B. Medial sesamoid nonunion combined with hallux valgus in athletes: a report of two cases. Foot ankle Int / Am Orthop Foot Ankle Soc [and] Swiss Foot Ankle Soc. 2006;27:135–40.

    Article  Google Scholar 

  21. Aper RL, Saltzman CL, Brown TD. The effect of hallux sesamoid excision on the flexor hallucis longus moment arm. Clin Orthop Relat Res. (1996); 209–217.

  22. Taylor CF, Butler M, Parsons SW. Problems associated with the excision of the hallux sesamoids. Foot Ankle Clin. 2014;19:425–36. doi:10.1016/j.fcl.2014.06.014.

    Article  PubMed  Google Scholar 

  23. Yang R, Chu Y. Hallucal sesamoiditis manifested on bone scan. Clin Nucl Me. 2013;38:1019–21. doi:10.1097/RLU.0000000000000283.

    Google Scholar 

  24. Ogata K, Sugioka Y, Urano Y, Chikama H. Idiopathic osteonecrosis of the first metatarsal sesamoid. Skelet Radiol. 1986;15:141–5. doi:10.1007/BF00350208.

    Article  CAS  Google Scholar 

  25. Waizy H, Jäger M, Abbara-Czardybon M, et al. Surgical treatment of AVN of the fibular (lateral) sesamoid. Foot ankle Int / Am Orthop Foot Ankle Soc [and] Swiss Foot Ankle Soc. 2008;29:231–6. doi:10.3113/FAI.2008.0231.

    Article  Google Scholar 

  26. Shibuya N, Davis ML, Jupiter DC. Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011). J Foot Ankle Surg. 2014;53:1–3. doi:10.1053/j.jfas.2014.03.011.

    Article  Google Scholar 

  27. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691–7. doi:10.1016/j.injury.2006.04.130.

    Article  PubMed  Google Scholar 

  28. Hennessy MS, Saxby TS. Traumatic “mallet toe” of the hallux: a case report. Foot Ankle Int. 2001;22:977–8.

    Article  CAS  PubMed  Google Scholar 

  29. Petnehazy T, Schalamon J, Hartwig C, et al. Fractures of the hallux in children. Foot ankle Int. 2015;36:60–3. doi:10.1177/1071100714552482.

    Article  PubMed  Google Scholar 

  30. Van Vliet-Koppert ST, Cakir H, Van Lieshout EMM, et al. Demographics and functional outcome of toe fractures. J Foot Ankle Surg. 2011;50:307–10. doi:10.1053/j.jfas.2011.02.003.

    Article  PubMed  Google Scholar 

  31. Eves TB, Oddy MJ. Do broken toes need follow-up in the fracture clinic? J Foot Ankle Surg. 2016;55:488–91. doi:10.1053/j.jfas.2016.01.034.

    Article  PubMed  Google Scholar 

  32. Martin EA, Barske HL, DiGiovanni BF. Open surgical treatment of an acute, unstable bony mallet injury of the hallux. Foot Ankle Int. 2013;34:295–8. doi:10.1177/1071100712465850.

    Article  PubMed  Google Scholar 

  33. Rapoff AJ, Heiner JP. Avulsion fracture of the great toe: a case report. Foot ankle Int / Am Orthop Foot Ankle Soc [and] Swiss Foot Ankle Soc. 1999;20:337–9. doi:10.1177/107110079902000514.

    Article  CAS  Google Scholar 

  34. Wada K, Yui M. Surgical treatment of mallet toe of the hallux with the extension block method: a case report. Foot Ankle Int. 2011;32:1086–8. doi:10.3113/FAI.2011.1086.

    Article  PubMed  Google Scholar 

  35. Nakamura S. Temporary Kirschner wire fixation for a mallet toe of the hallux. J Orthop Sci. 2007;12:190–2. doi:10.1007/s00776-006-1106-x.

    Article  PubMed  Google Scholar 

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Correspondence to Kenneth J. Hunt.

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Conflict of interest

Philip J York and Frank B Wydra declare that they have no conflict of interest.

Kenneth J Hunt reports grants from Acumed and ISAKOS outside of the submitted work.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Foot and Ankle Sports Medicine

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York, P.J., Wydra, F.B. & Hunt, K.J. Injuries to the great toe. Curr Rev Musculoskelet Med 10, 104–112 (2017).

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