Development of an injury risk function for first metatarsophalangeal joint sprains

Influence of forefoot bending stiffness on American football performance and metatarsophalangeal joint bending angle

Changes in forefoot bending stiffness have been shown to affect metatarsophalangeal peak bending angles as well as athletic performance. Increasing bending stiffness tends to reduce peak bending angles, which could potentially reduce hyperextension injuries such as turf toe. Limited information is available, however, on the efficacy of increasing forefoot bending stiffness on large-sized athletes such as those that participate in American Football, with prior studies being conducted on smaller athlete populations. Therefore, the purpose of this study was to determine the influence of increased forefoot bending stiffness on metatarsophalangeal joint extension and athletic performance of grid-iron football players. Ten varsity grid-iron football players performed four National Football League combine movements in a motion capture laboratory in three footwear conditions of varying bending stiffness: Soft (12.7 N/mm), Control (23.8 N/mm), Stiff (42.2 N/mm). None of the footwear conditions significantly altered the maximum metatarsophalangeal bending. Therefore, to reduce metatarsophalangeal hyperextension injuries in American football players a greater amount of forefoot bending stiffness may be required. Performance differences were present only during the five-metre sprint acceleration, with athletes having an improved performance in the Control and Stiff conditions. This improved performance was due to an increased horizontal impulse and improvements in power generation at the ankle joint.

First MTP joint instability - Expanding the concept of "Turf-toe" injuries

BACKGROUND

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.

METHODS

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.

RESULTS

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<0.001). The most frequent cause was axial load with various direction of stress at the first MTP. The mechanism of lesion varied among extension with hallux varism (42%), pure hyperextension (25%), extension with hallux valgism (21%), pure hyperflexion (8%) and hyperflexion with hallux valgism (4%). A separate analysis of each group showed a significant improvement in AOFAS Hallux scores after treatment: 51-84 (p<0.001) and 36-81 (p<0.001) for conservative and surgical groups, respectively. Four patients with GIII injuries (29%) and two with GII injuries (20%) did not resume their previous activities. Although pre-treatment AOFAS hallux scores were significantly different between groups, post-treatment scores were similar (p=0.615).

CONCLUSIONS

Turf-toe is a serious injury that may prevent a high percentage of patients from resuming their previous physical activities. Mechanism of lesion might be varied generating a wide range of lesions that fit into the expanded concept of the Turf-toe injury. Both forms of treatment lead to satisfactory results if well conducted. The correct identification, classification, and grading of first metatarsophalangeal joint (MTP) instability helps in decision making and selection of the adequate treatment.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Development of a Footwear Sizing System in the National Football League

Context:

Footwear performance and injury mitigation may be compromised if the footwear is not properly sized for an athlete. Additionally, poor fit may result in discomfort and foot injury such as fifth metatarsal stress fracture, foot deformities, turf toe, and blisters. Current footwear fitting methods consist of foot length and width measurements, which may not properly describe the shape of the individual foot, correlated with shoe size descriptors that are not standardized. Footwear manufacturers employ a range of sizing rubrics, which introduces shoe size and shape variability between and even within footwear companies. This article describes the synthesis of literature to inform the development and deployment of an objective footwear fitting system in the National Football League (NFL). The process may inform athletic footwear fitting at other levels of play and in other sports.

Evidence Acquisition:

Literature related to footwear fitting, sizing, and foot scanning from 1980 through 2017 was compiled using electronic databases. Reference lists of articles were examined for additional relevant studies. Sixty-five sources are included in this descriptive review.

Study Type:

Descriptive review.

Level of Evidence:

Level 5.

Results:

Current methods of footwear fitting and variability in the size and shape of athletic footwear complicate proper fitting of footwear to athletes. An objective measurement and recommendation system that can match the 3-dimensional shape of an athlete’s foot to the internal shape of available shoe models can provide important guidance for footwear selection. One such system has been deployed in the NFL.

Conclusion:

An objective footwear fitting system based on 3-dimensional shape matching of feet and shoes can facilitate the selection of footwear that properly fits an athlete’s foot.

The Athletic Shoe in Football

BACKGROUND

Foot and ankle injuries are common in sports, particularly in cleated athletes. Traditionally, the athletic shoe has not been regarded as a piece of protective equipment but rather as a part of the uniform, with a primary focus on performance and subjective feedback measures of comfort. Changes in turf and shoe design have poorly understood implications on the health and safety of players.

EVIDENCE ACQUISITION

A literature search of the MEDLINE and PubMed databases was conducted. Keywords included athletic shoewear, cleated shoe, football shoes, and shoewear, and search parameters were between the years 2000 and 2016.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 5.

RESULTS

The athletic shoe is an important piece of protective sports equipment. There are several important structural considerations of shoe design, including biomechanical compliance, cleat and turf interaction, and shoe sizing/fit, that affect the way an athlete engages with the playing surface and carry important potential implications regarding player safety if not understood and addressed.

CONCLUSION

Athletic footwear should be considered an integral piece of protective equipment rather than simply an extension of the uniform apparel. More research is needed to define optimal shoe sizing, the effect that design has on mechanical load, and how cleat properties, including pattern and structure, interact with the variety of playing surfaces.

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.

Incidence and Severity of Foot and Ankle Injuries in Men's Collegiate American Football

Background:

American football is an extremely physical game with a much higher risk of injury than other sports. While many studies have reported the rate of injury for particular body regions or for individual injuries, very little information exists that compares the incidence or severity of particular injuries within a body region. Such information is critical for prioritizing preventative interventions.

Purpose:

To retrospectively analyze epidemiological data to identify the most common and most severe foot and ankle injuries in collegiate men’s football.

Study Design:

Descriptive epidemiology study.

Methods:

Injury data were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for all foot and ankle injuries during the 2004-2005 to 2008-2009 seasons. Injuries were analyzed in terms of incidence and using multiple measures of severity (time loss, surgeries, medical disqualifications). This frequency and severity information is summarized in tabular form as well as in a 4 × 4 quantitative injury risk assessment matrix (QIRAM).

Results:

The rate of foot and ankle injuries was 15 per 10,000 athletic exposures (AEs). Five injuries were found to be responsible for more than 80% of all foot and ankle injuries: lateral ankle ligament sprains, syndesmotic (high ankle) sprains, medial ankle ligament sprains, midfoot injuries, and first metatarsophalangeal joint injuries. Ankle dislocations were found to be the most severe in terms of median time loss (100 days), percentage of surgeries (83%), and percentage of medical disqualifications (94%), followed by metatarsal fractures (38 days, 36%, and 49%, respectively) and malleolus fractures (33 days, 41%, and 59%, respectively). Statistical analysis suggests that the 3 measures of severity are highly correlated (r > 0.94), thereby justifying the use of time loss as a suitable proxy for injury severity in the construction of the QIRAM.

Conclusion:

Based on the QIRAM analysis, the 5 highest risk injuries were identified based on both incidence and severity (ankle dislocations, syndesmotic sprains, lateral ankle ligament sprains, metatarsal fractures, and malleolus fractures). A better understanding of the relative incidence and severity of these injuries will allow coaches, trainers, and researchers to more effectively focus their preventative interventions.