When Turf Toe Strikes, You’ll Know What To Do

Turf toe is not a term you want to use when talking to a ballerina before her diva debut or a head football coach about his star running back.

“Turf toe” is the common term used to describe a sprain of the ligaments around the big toe joint. Although associated with athletes who play sports on artificial turf or hard surfaces, such as soccer, basketball, wrestling, gymnastics, and dance, it can happen to anyone! It’s a condition that’s caused by jamming the big toe or repeatedly pushing off the big toe forcefully as in running and jumping.

What Causes Turf Toe?

Turf toe is a sprain to the ligaments around the big toe joint, which works primarily as a hinge to permit up and down motion.

Just behind the big toe joint in the ball of your foot are two pea-shaped bones embedded in the tendon that moves your big toe called sesamoids. These bones work like a pulley for the tendon and provide leverage when you walk or run. They also absorb the weight that presses on the ball of the foot.

When you are walking or running, you start each subsequent step by raising your heel and letting your body weight come forward onto the ball of your foot. At a certain point you propel yourself forward by “pushing off” of your big toe and allowing your weight to shift to the other foot. If the toe for some reason stays flat on the ground and doesn’t lift to push off, you run the risk of suddenly injuring the area around the joint. Or if you are tackled or fall forward and the toe stays flat, the effect is the same as if you were sitting and bending your big toe back by hand beyond its normal limit, causing hyperextension of the toe. That hyperextension, repeated over time or with enough sudden force, can — cause a sprain in the ligaments that surround the joint.

What Are the Symptoms of Turf Toe?

The most common symptoms of turf toe include pain, swelling, and limited joint movement at the base of one big toe. The symptoms develop slowly and gradually get worse over time if it’s caused by repetitive injury. If it’s caused by a sudden forceful motion, the injury can be painful immediately and worsen within 24 hours. Sometimes when the injury occurs, a “pop” can be felt. Usually the entire joint is involved, and toe movement is limited.

How Is Turf Toe Diagnosed?

To diagnose turf toe, the doctor will ask you to explain as much as you can about how you injured your foot and may ask you about your occupation, your participation in sports, the type of shoes you wear, and your history of foot problems.

The doctor will then examine your foot, noting the pattern and location of any swelling and comparing the injured foot to the uninjured one. The doctor will likely ask for an X-ray to rule out any other damage or fracture. In certain circumstances, the doctor may ask for other imaging tests such as a bone scanCT scan, or MRI.

How Is Turf Toe Treated?

The basic treatment for treating turf toe, initially, is a combination of rest, ice, compression, and elevation (remember the acronym R.I.C.E).This basic treatment approach is to give the injury ample time to heal, which means the foot will need to be rested and the joint protected from further injury. The doctor may recommend an over-the-counter oral medication such as ibuprofen to control pain and reduce inflammation. To rest the toe, the doctor may tape or strap it to the toe next to it to relieve the stress on it. Another way to protect the joint is to immobilize the foot in a cast or special walking boot that keeps it from moving. The doctor may also ask you to use crutches so that no weight is placed on the injured joint. In severe cases, an orthopaedic surgeon may suggest a surgical intervention.

It typically takes two to three weeks for the pain to subside. After the immobilization of the joint ends, some patients require physical therapy in order to re-establish range of motion, strength, and conditioning of the injured toe.

Can Turf Toe Be Prevented?

One goal of treatment should be to evaluate why the injury occurred and to take steps to keep it from reoccurring. One way to prevent turf toe is to wear shoes with better support to help keep the toe joint from excessive bending and force with pushing off. You may also want to consider using specially designed inserts that your doctor or physical therapist can prescribe for you.

A physical therapist or a specialist in sports medicine can also work with you on correcting any problems in your gait that can lead to injury and on developing training techniques to help reduce the chance of injury.

 Contributed by Aetrex

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The Importance of Strengthening the Gymnast’s Elbow

By Tara Hackney, PT, DPT, OCS, KTTP for Atletico Physical Therapy

strengthening gymnasts elbowGymnastics offers a unique perspective, even allowing some athletes to see the world upside down!

Very few sports involve supporting the entire body weight with the arms like gymnastics. Due to these special considerations, gymnasts are more prone to certain injuries, such as Osteochondritis Dissecans of the elbow (OCD), and should take care to strengthen the entire arm to decrease injury risk.

What is OCD Elbow?

Osteochondritis Dissecans (OCD) lesions can be found in the elbows of adolescent athletes. The exact cause of OCD in the elbow is unknown, but repetitive microtrauma and decreased blood flow to the subchondral bone are believed to play a role. As the underlying bone weakens, a segment of the articular cartilage separates from the subchondral bone, forming a lesion. OCD lesions in gymnasts may be caused by repetitive weight bearing on the hands with the elbow in extension.

Presentation of elbow OCD is very vague. A patient can have pain, tenderness and swelling over the lateral aspect of the elbow. There may be limitation in how straight the elbow can go and there may be locking or catching if the injury has progressed. However, tendinitis of the elbow can have a similar presentation. More often OCD is suspected in specific patient populations including pre-teen and teenage gymnasts as well as young baseball pitchers with elbow pain. Diagnosis is through imaging such as x-ray or MRI.

Treatment for OCD Elbow

Non-operative treatment for elbow OCD consists of rest and sports restriction. For a gymnast that means no weight bearing on arms and no hanging from bars or rings as the latter puts traction stress through the elbow. Muscle strengthening exercises and possibly a short period of immobilization are also usually a part of treatment.

There are some cases where the lesion is unstable and surgery is the best option. After surgery, physical therapy is performed to reduce pain, swelling and restore range of motion. Resistance strengthening is also incorporated into the rehabilitation after bone healing has occurred, usually around 8 weeks after surgery.

What Can Athletes Do While Resting Their Elbow?

If a gymnast has been diagnosed with an OCD lesion, they are not allowed to do any weight bearing on the arm, which includes performing skills on the bars. So what can the gymnast do as they allow their elbow to heal? Core strengthening is one option, as core strength is vital to a gymnast and is important during all events. Leg strengthening can also be performed while adhering to the restrictions on the elbow. An overall conditioning program can be designed for the athlete that will incorporate cardio, core strengthening, leg strengthening, shoulder and wrist strengthening, and flexibility stretching. Staying active and in shape is vital to the gymnast during this time to assist in returning to the sport when the elbow restrictions are lifted.

Arm Strengthening for Gymnasts

The elbow is the middle joint of the arm with the shoulder and wrist on either side. While the gymnast’s elbow is healing, it is important to strengthen both of the surrounding joints to provide extra stability for the arm for when return to weight bearing is allowed. Prior to initiating any activities, ensure the gymnasts’ physician has cleared them for return to these exercises.

            Shoulder strengthening examples:

  • Resistance band exercises including rows, shoulder extension, diagonals, internal/external rotation
  • Sidelying shoulder external rotation
  • Tricep extension with band or hand weight
  • Bicep curls with band or hand weight
  • Prone I, T, Y exercises – exercises can be performed using a swiss ball for added core activation, hand weights can be added for resistance
  • Gradual return to weight bearing exercises, like push-ups, planks and handstands, can be added when the athlete is cleared from restrictions

            Wrist strengthening examples:

  • Wrist curls in both directions with a weight or resistance band
  • Gripping exercises for the hands
  • Wrist rotation exercises, such as hand weight rolling
  • Supination/Pronation with a hand weight

Arm Stretching for Gymnasts

  • Wrist flexor stretch
  • Wrist extensor stretch
  • Cross body shoulder stretch
  • Tricep stretch
  • Shoulder flexion stretch on foam roller, wall, or mats
  • Shoulder circles – lie on your side on the floor and draw a circle on the floor with your top arm by rotating your upper body
  • Doorway stretch

Strengthening the Upper Body

Gymnasts have special considerations due to the nature of their sport with weight bearing on the arms. This can lead to injuries of the elbow such as OCD lesions. Strengthening of the entire upper body, including shoulder and wrists, should be incorporated into a conditioning program for both healthy gymnasts and gymnasts recovering from an elbow injury.

For more information, contact an Athletico clinic close to you for a complimentary injury screening.

Schedule a Complimentary Injury Screen

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Donor Family Shares Story of Hope; Zach Miller Knee Injury; Cheerleader Injuries

Episode 17.30 Rerun

Segment One (01:30): The Healing Process of Donor Parents Lori and Rob Chana.

Cameron Chana (2)Cameron Chana was a born leader who focused on making an impact in lives of others. He was very involved in volunteer work, his church, and went on mission trips across the world. No matter where he was, he encouraged positivity and spread his caring, upbeat energy.

The Chana family’s world was turned upside down when twenty-two-year old Cameron was killed in a bus accident in 2009. During a time of unimaginable grief, his parents and three siblings honored his wish to be a donor.

Cameron’s legacy of hope and love lives on through the gift of organ and tissue donation. He saved five lives through organ donation and impacted as many as 50 lives through tissue donation. Learn more at AllowSource.

Lori & Rob Chana with Steve and Dr. Cole

Chana family with Cameron on the Left

Cameron’s heart recipient


Segment Two (14.12): Steve and Dr. Cole talk with former Chicago Bear Otis WilsonUSP NFL: CHICAGO BEARS AT NEW ORLEANS SAINTS S FBN NO CHI USA LA about Zach Millers horrific knee injury in the recent game against the New Orleans Saints. Chicago Bears Zach Miller had emergency surgery last week to repair a torn popliteal artery in his left leg, an injury that has resulted in amputation in some previous instances involving other football players. The 33-year-old dislocated his left knee while trying to catch a touchdown pass, which subsequently damaged the artery.


Segment Three (21:04): Dr. Kathy Weber from Midwest Orthopaedics at Rush talksabout the prevalence of catastrophic injuries and concussions in cheerleaders. Cheerleading is by far the most perilous sport for female athletes in high school and college, accounting for as much as two-thirds of severe school-sports injuries over the past 25 years, according to a new report. Yet cheerleading remains one of the least-regulated sports, despite more than 95,000 high school girls and 2,000 boys signing up for spirit squads nationwide each year.


kathleen weberDr. Weber’s reputation as a leading sports medicine physician is enhanced by her remarkable activity in the treatment of high-level professional athletes. She serves as the head primary care sports medicine team physician for the Chicago Bulls and the Chicago White Sox and the head team physician for the Chicago Force Women’s Football. She also serves as co-head team physician for the DePaul Blue Demons and the physician for the Hubbard Street Dance and the River North Dance Companies. In addition, she is a member of the LPGA Medical Advisory Board. She is on numerous committees including the NBA Team Physicians Executive Committee, NBA Research Committee, MLB Concussion Committee, and MLB Research Committee. Dr. Weber has been involved with the MLB Medical Advisory Board for multiple years and is the first women elected President of the MLB Team Physicians Association.

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After 8 Failed Surgeries, Athlete’s Foot Gets Proper Care by Dr. Lin

Sept. POM Kelsie photo 1.jpg

Kelsie Hannigan, 17, was a typical high school student at Lincoln Way Central. She loved going shopping, hanging out with friends, and has been devoted to tumbling, gymnastics, and cheerleading since she was three years old.

While tumbling in cheer one day, Kelsie was practicing a full – a very impressive backflip with a twist – and abruptly landed on her left foot. She knew this was different from other times.

She sought advice from two or three doctors, all of whom told her to wait and see if it would heal on its own. Unfortunately, it didn’t.

One doctor diagnosed the damage as a Linsfrac fracture and agreed to perform surgery. About two weeks post-operation, however, she was still feeling severe pain in her foot and new pain in her ankle. Kelsie ended up being on and off crutches and in and out of the hospital for a year, unable to return to cheerleading, tumbling, or any physical activity. She underwent more surgeries to insert anchors, remove anchors, and repair bones.

One year and eight surgeries later, Kelsie had seen no improvement in her pain and didn’t know what to do. At this point, she had more injuries than she had started with, including recurrent popping in the lateral aspect of her ankle and chronic dislocation of her peroneal tendon.

Finally, six months after her last surgery, she discovered Dr. Johnny Lin at Midwest Orthopaedics at Rush. She was initially cautious about surgery, but refreshingly hopeful about this new surgeon.

“Dr. Lin told me everything he was going to do,” she explains. “I wasn’t scared about what was going to happen. He told me all the risks and reassured me that it would be okay.”

Earlier this year, Dr. Lin performed a left ankle fibular exostectomy, hardware removal, calcaneal hardware removal, peroneal tenolysis and debridement, peroneal groove deepening, and superior peroneal retinacularplication to repair Kelsie’s foot and ankle.

Kelsie was impressed at how capable Dr. Lin was and how quickly her recovery progressed – this experience was much different than her past surgeries. She spent six weeks on crutches and two more in a boot.

“It was amazing having just one surgery,” she says. “Before, we never knew if it would be the last one. This time, even right afterward, we knew.”

Kelsie continued with six weeks of physical therapy to get stronger and to rebuild the physical stability in her foot and ankle. She has gone running a couple times but is still cautious when it comes to cheer and tumbling.

Sept. POM Kelsie photo 2.jpg

Instead, she spends more time coaching gymnastics and tumbling for kids up to 11 years old. She has a blast teaching and is happy that she can be more involved in the physical requirements of her job.

Kelsie is relieved to be in less pain and looking forward to returning to her very active life. She is finally able to enjoy doing everyday things, such as going shopping or going out to eat with friends, that she missed out on because of severe foot and ankle pain. Less than two months post-operation, she even made it out of the boot for her mother’s wedding.

She is grateful to be progressing in recovery and returning to her life.

“Dr. Lin knew what he was talking about and knew he could make it better. He went in and fixed everything.”

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