Great toe chondral injury

This 19-year-old male international player presents with recurring episodes of pain in his great toe. He described a catching sensation, followed by significant and severe pain. These episodes generally last less than a minute and are unpredictable. Between these episodes he is entirely asymptomatic and is able to train without any impairment. There were no significant examination findings.

X-ray images of the forefoot were normal. MRI showed an osteochondral lesion involving the medial condylar head with thickening and altered signal of the overlying cartilage and suspected delamination at its plantar margin. This measures 7 x 7 mm and is associated with an area of focal flattening and deformity.

The MRI findings were discussed with the player. A number of options, including a chondroplasty, were discussed with this player. After this conversation he elected to manage this problem with a further period of observation, podiatry input and a trial of taping. His symptoms improved over a six-month period.

The great toe can be a cause of surprising morbidity among football players. The first MTPJ undergoes considerable load while walking (0.4-0.6 times body weight), running (2-3 times body weight), and jumping (8 times body weight). Chondral injuries, sesamoid problems, hallux valgus and plantar plate injuries can all create a significant problem. Injuries most commonly occur after an injury involving forced dorsiflexion however pain can also be related to repetitive sub-clinical trauma.

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