First MTP joint instability — Expanding the concept of “Turf-toe” injuries

•Our study brings a new perspective about “Turf Toe” injuries.•A large diversity of sports being practiced when the injury occurred and different types of injury mechanism are described.•First collect data of this type of injury in players of sports other than American Football (a large series - midterm FU). Although the classic definition of the Turf-toe injury refers to a very specific clinical and pathological picture, we think that the concept can be broadened to encompass a wide variety of traumatic lesions of the first metatarsophalangeal joint (MTP1). These are lesions typically difficult to diagnose, with a large variation of outcomes and a potential to impair patients’ functional performance on a definitive and perennial basis. The objective of this study is to present the result obtained by treating 24 cases of traumatic injuries to the MTP1 joint in a midterm follow-up time. In the period from 1999 to 2016, 24 patients were treated with MTP1 joint instability – “Expanded Turf-toe” – diagnosis. All patients were performing sports activities when they were injured: soccer (33%); martial arts (17%); running (13%); tennis (8%); olympic gymnastics (8%) and others (basketball, slalom, motorcycling, surfing, and ballet) (21%). Injuries were classified as Grade I (2 patients — 8%), Grade II (8 patients — 33%) and Grade III (14 patients — 59%) lesions. All patients with grades I and II were treated conservatively whereas those classified as grade III were treated surgically. After an average follow-up of 4.5 years we observed an improvement in the AOFAS hallux score from 42 to 82 points after treatment (p