Duke’s Freshman Star Kyrie Irving Injures Big Toe
Kyrie Irving, Duke’s stand out freshman point guard suffered a right big toe joint injury last week. There has been a lot of speculation as to the extent of his injury, with details slowly becoming available. Although I am not involved in his care, from the mechanism of the injury, the comments that Coach K has made, and what is available in the media to date, it seems that the injury is most worrisome for a turf toe injury.
The great/big toe “knuckle” joint (also known as the first metatarsal-phalangeal joint/1st MTP) is made of two bones: the first metatarsal and the proximal phalanx. Underneath the 1st metatarsal (plantar), live two smaller bones, known as the sesamoids. The sesamoids live on one of the small muscles of the foot. From the sesamoids to the base of the proximal phalanx is a structure known as the plantar plate. There are a variety of other smaller ligaments that work together to stabilize the sesamoids and the 1st MTP.
A turf toe injury occurs when there is damage to the plantar plate or the sesamoid ligament complex. This injury causes more lost days of practice in the NFL than ankle sprains. It is occurring more frequently in sports, especially when played on artificial turf.
Turf toe injuries occur more often in running type sports, such as football, soccer, and basketball. The injury occurs when a force comes through the heel with the ankle pointed downward and the 1st MTP pointed upwards (see picture below). This force can cause stretching or tearing of the plantar/bottom capsule or ligamentous structures which can then lead to the 1st MTP being unstable.
Individuals with turf toe injuries experience pain and swelling in the 1st MTP. There may be decreased push-off strength and the inability to participate in cutting or jumping activities.
Turf toe injuries are becoming more frequently diagnosed as orthopaedic surgeons learn to recognize this injury. There are 3 grades of turf toe injuries depending on the severity of the injury. Grad 1 is a stretching of the capsule, ligaments, or plantar plate. Grade 2 is a partial tear of any of these structures. Grade 3 is a complete tear of the any of these structures. With any of these grades, associated injuries can also occur, such as a fracture of the sesamoids or phalanx or an osteochondral (OCD) lesion of the head of the 1st metatarsal (which is like a pot hole developing in the smooth surface of the joint).
Treatments are based on the severity and grade of the turf toe injury. Grade 1 is usually treated with taping and early rehabilitation to prevent stiffness. Grade II injuries are treated with taping, a carbon fiber insole to stiffen the shoe and minimize the motion of the joint, and early rehabilitation. Grade 3 injuries are treated with a cast or surgery. The surgery is aimed to repair the damaged tissues. A video of such a surgery can be seen at: http://www.youtube.com/NCOCatDuke#p/u/4/aLes1tTRs0g.
WHEN TO SEEK MEDICAL CARE
If you suspect that you have a turf toe injury, you should seek medical attention within 1-2 weeks. Diagnosis starts with the good physical exam. Then x-rays are used to look for obvious bone misalignments and fractures or breaks. An MRI may be needed.
RETURN TO ACTIVITIES/OUTCOMES
Return to sports depends on the grade of the injury. Grade 1 injuries will return to play as tolerated. Grade 2 injuries are out of competitive play for at least 2 weeks. Grade 3 injuries can be out of play for up to 6 to 12 months.
A video of turf toe surgery can be seen at: http://www.youtube.com/NCOCatDuke#p/u/4/aLes1tTRs0g.
Until we have more information on the severity of Irving’s injury, it will be difficult to know how long he will be out of action.
All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.