Return to Sport Following Turf Toe Injuries: A Systematic Review and Meta-Analysis

CATEGORY: Sports INTRODUCTION/PURPOSE: The prevalence of turf toe injuries has increased in recent years due to heightened awareness and the large number of athletes participating in sports today. Uncertainty remains, however, as to how to properly treat turf toe and the prognosis for these injured athletes. The purpose of this study was to systematically review the literature to provide recommendations on treatment of turf toe and expectations for outcomes and return to play. METHODS: Following PRISMA criteria, a systematic review and meta-analysis using the PubMed/Ovid Medline/PMC databases was performed (May 1964 – August 2018). Studies evaluating non-turf toe injuries, biomechanical studies, and those written in non- English language were excluded. Return to sport, treatment, severity of injury, athletic position, and sport were recorded and statistically analyzed. RESULTS: 12/944 studies met criteria, which included 112 athletes and 120 turf toe injuries. The athletes played a variety of sports: football (111), basketball (2), soccer (1), and track (3). 58 of these injuries were treated non-operatively, while 62 required surgery. There was one grade 1 injury, ten grade 2 injuries, and fifty-four grade 3 injuries. Fifty-five injuries were unclassifiable and excluded. Return to sport for patients treated non-operatively was 5.9 weeks versus 19.2 weeks in patients treated operatively (p=0.007). Patients with a grade 2 injury returned to sport quicker (11.7 weeks) than patients with grade 3 injuries (19.9 weeks) (p=0.016). Return to play was different according to the athlete’s level of play (13.9 weeks high school, 16.8 weeks college, 14.4 weeks professional) (p=0.018). CONCLUSION: Return to sport in patients suffering from a turf toe injury can be affected by either the severity of injury and/or level of competition of the athlete. However, this study also acknowledges the limited number of high level studies evaluating turf toe in the athletic population. Further research is necessary to clearly define appropriate treatment and return to play protocols based on sport, position, and level of play.