Foot & Ankle International - June 2017 - 590

697961

FAIXXX10.1177/1071100717697961Foot & Ankle InternationalCovell et al

research-article2017

Article

Operative Treatment of Traumatic
Hallux Valgus in Elite Athletes

Foot & Ankle International®
2017, Vol. 38(6) 590-595
© The Author(s) 2017
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https://doi.org/10.1177/1071100717697961
DOI: 10.1177/1071100717697961
journals.sagepub.com/home/fai

D. Jeff Covell, MD, MPH1, Craig R. Lareau, MD1,
and Robert B. Anderson, MD1,2

Abstract
Background: Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique
variant of turf toe. Failure to appropriately recognize and treat these injuries can lead to continued pain, decreased
performance, progressive deformities, and ultimately degeneration of the hallux metatarsophalangeal joint. Limited
literature currently exists to assist in the diagnosis, management, and operative treatment.
Methods: Nineteen patients were reviewed in this series, including 12 National Football League, 6 college, and 1 high
school player who was a college prospect. The average age for all patients at the time of surgery was 24.4 years (range,
19-33 years). Return to play and complications were evaluated.
Results: Overall, good operative results were obtained, with 74% of patients returning to their preinjury level of play at
an average recovery time of 3.4 months.
Conclusion: Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique
variant of turf toe. The impact of this injury cannot be overstated, as one-quarter of players were unable to return to play.
Level of Evidence: Level IV, case series.
Keywords: traumatic hallux valgus, bunion, turf toe, athlete, sports
Turf toe encompasses a wide spectrum of injury types and
severity to the hallux metatarsophalangeal (MTP) joint and
can be a common cause of disability among elite athletes.
Hyper-dorsiflexion with the addition of a valgus load can
lead to traumatic hallux valgus (THV) with the medial collateral ligament (MCL) and varying degrees of plantar
plate-sesamoid complex-flexor hallucis brevis (FHB) tendon ruptures. This represents a unique variation to the
common turf toe injury and can result in acute or chronic
pain, progressive valgus malalignment (Figure 1), diminished performance, and progressive degeneration of the
hallux MTP joint.
It has been the observation of the senior author (R.B.A.)
that this injury pattern is underrecognized, particularly in
American football, and is an important variant to the classic
hyperextension turf toe injury. Identifying and understanding the subtle difference in this injury pattern are imperative
in avoiding long-term consequences of an untreated injury.
Limited literature currently exists to assist in the diagnosis,
management, and operative treatment. The aim of this article is to increase awareness of this injury, provide treatment
guidelines, and describe an operative technique for repair as
well as to report the experience of the senior author in treating these complex injuries in elite athletes in a consecutive
case series.

Methods
This retrospective series was approved by an institutional
review board. Between 2006 and 2015, 19 male athletes who
underwent operative treatment of THV by a single foot and
ankle fellowship-trained orthopaedic surgeon were identified. The diagnosis of a traumatic etiology was identified
from the patient's history in combination with examination
findings showing asymmetric hallux valgus with progression over a short period. The indication for operative intervention was documented valgus instability of the hallux
MTP joint with a progressive, asymmetric hallux valgus
deformity, assessed using physical examinations, standing
radiographs of both feet, and fluoroscopic stress testing.
The average age for all patients at the time of surgery
was 24.4 years (range, 19-33 years). Nineteen patients were
reviewed in this series, including 12 National Football
1

OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA
Department of Orthopaedic Surgery, Carolinas Medical Center,
Charlotte, NC, USA
2

Corresponding Author:
D. Jeff Covell, MD, MPH, OrthoCarolina Foot and Ankle Institute,
2001 Vail Avenue Suite 200B, Charlotte, NC 28207, USA
Email: djeffcovell@gmail.com


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Table of Contents for the Digital Edition of Foot & Ankle International - June 2017

Contents
Foot & Ankle International - June 2017 - Intro
Foot & Ankle International - June 2017 - Cover1
Foot & Ankle International - June 2017 - Cover2
Foot & Ankle International - June 2017 - i
Foot & Ankle International - June 2017 - ii
Foot & Ankle International - June 2017 - Contents
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Foot & Ankle International - June 2017 - CT1
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Foot & Ankle International - June 2017 - 4A
Foot & Ankle International - June 2017 - 4B
Foot & Ankle International - June 2017 - Cover3
Foot & Ankle International - June 2017 - Cover4
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