Disorders of the big toe are common on the general population, but even commoner in sportsmen especially footballers. Arthroscopy (keyhole surgery) is now routine using a tiny camera to inspect and treat problems inside the joint.
The commonest condition occurring through sport is what the Americans call “turf toe”. Over half of professional American footballers have some symptoms often ascribed to a bad sprain on artificial surfaces! The injury is usually caused by forcing the toe upwards, stretching the soft tissues supporting the joint in the sole. There is often marked bruising and pain after the injury, and sometimes a tiny flake fracture is seen, occasionally there has been a dislocation of the joint which has popped back in spontaneously. Surgery is rarely necessary acutely, but some athletes go on to suffer long term problems which can be disabling. This is sometimes caused by damage to the articular surface which can be treated in the same way as in the knee, but it is also associated with problems with the sesamoid bones. These are small ossicles in the two tendons which pull the toe down and act (like the knee cap) to increase the lever arm of action of the tendons by holding them away from the axis of the joint. Sesamoiditis, osteochondritis, avascular necrosis, congenital anomalies, fractures and osteoarthritis are all seen in athletes’ toes and the sesamoids may need either trimming or occasionally removing if all else fails. In general the treatment is non-surgical, with physiotherapy, medication and orthoses.