Open lateral collateral ligament injury of the interphalangeal joint of the great toe in adolescents during Taekwondo

Abstract

BACKGROUND: Sports-related open lateral collateral ligament injury of the interphalangeal joint of the great toe has not been previously described in the English literature. HYPOTHESIS: This injury can occur in adolescents while performing barefooted high-kicking or fast-running exercises involving rapid, 180 degrees turns on a dry, rough, wooden floor in a Taekwondo gymnasium. Injury occurs when the whole body turns quickly while supported only by the plantar aspect of the distal phalanx of the great toe. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The 7 study subjects consisted of 6 boys and 1 girl between 10 and 16 years old. Causes, pattern, mechanism of injury, treatment, and outcomes were investigated. RESULTS: All patients showed the same injury pattern and mechanism. They all had an open wound on the dorsolateral aspect of the interphalangeal joint. It was postulated that rapid whole body turning supported only by the distal phalanx of the great toe produces nonphysiologic varus stress at the interphalangeal joint, which results in open detachment of the lateral collateral ligament and adjoining periosteum from the proximal phalanx and interphalangeal joint subluxation. All 7 patients regained full great toe function after surgical repair. CONCLUSION: This unique sports-related open interphalangeal joint injury should be recognized. Participants, trainers, and health providers engaged in Taekwondo or similar sports should understand the pathomechanism of this injury and develop preventive measures.