A 23-year-old American football player playing on artificial turf develops severe pain and swelling at the plantar aspect of the first metatarsophalangeal joint after forcible hyperextension of the great toe. Radiographs are normal. What is the diagnosis?

• A Hallux rigidus with degenerative cartilage loss
• B Turf toe, a sprain of the plantar capsule and sesamoid complex ✓
• C Stress fracture of the first metatarsal shaft
• D Sesamoid dislocation without soft tissue injury

Explanation

Turf toe is a hyperextension injury of the first metatarsophalangeal joint damaging the plantar plate, capsule and sesamoid apparatus, classically on artificial turf with flexible footwear. Acute onset after a defined hyperextension event with normal radiographs fits the sprain rather than hallux rigidus, which is chronic degenerative stiffness developing over years. B metatarsal shaft stress fracture would show insidious onset and focal cortical changes on delayed imaging, not acute capsular swelling.

Reference: Apley and Solomon's System of Orthopaedics and Trauma, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.