On Monday, May 1st in a AL central division contest against the Tigers, Austin Jackson came up limping while trying to beat a throw to first base. Jackson appeared to contact the edge of first base with the toes of his left foot, following a hard hit ball to Jose Iglesias. Jackson had to be removed from the game and landed on the 10-day disabled list on May 2nd with a diagnosis of a left great toe hyperextension.
What is it? The great toe, or the big toe in layman’s terms, plays an important role with most aspects of the foot. This toe is responsible for pushing off the ground while walking and running to propel the foot/leg forward and is also responsible for pushing off the ground while jumping. The term “hyperextension” refers to excessive or increased extension of a particular joint. Joints throughout the body are only intended to have a certain degree of mobility; any mobility greater than what is considered normal is termed “hypermobile” and mobility less than what is considered normal is termed “hypomobile”. The degree of hyperextension can be graded based on severity with grade one hyperextensions being the least severe and grade three hyperextensions being the most severe. Grade one hyperextension injuries to the great toe involve over stretching of the structures on the bottom of the big toe, grade two injuries involve partial tearing of those same structures and grade three hyperextension injuries involve complete tearing. Another commonly used term for a hyperextension injury of the great toe is “turf toe”.
How is fixed? The treatment for hyperextension injuries of the great toe will vary based off severity. Grade one injuries usually respond well to utilization of the common acronym RICE, which stands for rest, ice, compression, elevation. Additionally, techniques to ensure the toe does not become hyperextended again are also utilized. Such methods, include but are not limited to, taping, splinting or use of orthotics. Grade two injuries are managed similarly to grade one injuries via RICE and may require a period of immobilization. Overall return to play time is also slightly longer than that of a grade one injury. Finally, grade three hyperextension injuries will involve a longer period of immobilization than grade two injuries, again with a longer return to play time. Rehab in the form of physical therapy, if deemed necessary, will emphasize maintaining adequate strength and range of motion of the of joints and muscle of the foot/ankle. Once pain in the great toe has reduced, an effort to normalize walking, running and jumping patterns is emphasized. The last stage of rehab before return to play involves sport specific activities; when considering a major league baseball player these activities include throwing, running, batting and fielding in controlled situations prior to returning to live game action.
My take. The Indians have not offered clarification as to the severity of Austin Jackson’s injury, so it is difficult to determine a timetable for his return to patrolling centerfield for the Tribe. The severity of the injury dictates whether Jackson misses ten days or several weeks. However, the good news is, great toe, hyperextension injuries usually respond very well to therapeutic intervention and usually do not limit individuals from returning to their previous level of participation in sport.
We will continue to monitor the status of Austin Jackson as he progresses through the rehabilitation process and will provide up to date injury analysis and explanation as new information becomes available.
Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio. He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports. Follow Brandon on Twitter for more Cleveland Indians injury insight and analysis: @blbowers12
The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available. This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.