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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Donation Comes Full Circle For Tissue Recipient Turned Doctor

As a soccer player for the University of Illinois, Rachel constantly pushed herself. Being active was crucial to her lifestyle both on and off the soccer field. She was also passionate about medicine, but didn’t know yet that she would eventually be on both sides of the operating table.

After a partial lateral meniscus tear put her on the sidelines, she underwent an arthroscopic partial lateral meniscectomy. She returned to soccer and her pre-injury level of play until she tore her remaining meniscus.

Her pain subsided after an arthroscopic procedure to have the non-viable tissue removed, but then her knee issues returned. “Being unable to remain physically fit, or lead an active lifestyle, became a huge problem for me,” she said. “As sports and fitness, particularly soccer, were such huge components of my life, I was extremely frustrated with my knee.”

When Rachel met with Dr. Brian Cole of Rush University Medical Center, she learned she was a candidate for a meniscus transplant. Since donor meniscus tissue is matched to the recipient by size, she was placed on a waiting list. Three weeks before starting medical school, she received her match.

In addition to balancing her recovery and a strict physical therapy regimen, Rachel focused on medical school.  She also began running again and completed the Chicago Triathlon in 2008.

Throughout the course of medical school, Rachel’s experience with allograft transplantation stayed with her and would eventually help shape the course of her career. “As a direct reflection of my fascination with musculoskeletal function laid against the backdrop of my own patient experiences, I pursued a yearlong Orthopaedic Research Fellowship within the Division of Sports Medicine in the Department of Orthopaedic Surgery at Rush University Medical Center,” she explained.

During her research year, Rachel started training for and subsequently completed the Hawaii Half-Ironman. While she was preparing for the race, some of her knee symptoms came back. After the race, she required a revision of the meniscus allograft and received a lateral femoral condyle osteochondral allograft. “Ever since the revision surgery, I have been functioning at an incredibly high level,” Rachel said.

Now an orthopedic surgery resident at Rush University Medical Center, Rachel works alongside Dr. Cole, the surgeon who helped her heal. Many of her research projects involve allograft applications and her experience as an allograft recipient provides a unique connection to her patients in need of a tissue transplant.  “The allograft has allowed me to be a surgeon, permitting me to stand for over 12 hours in the operating room without thinking about my knee because I have literally no pain or swelling,” she said. “Before the allograft transplantation, there is no way I would have been able to do this. I am incredibly grateful for my tissue donors and their families. This gift has inspired me to pursue my passion for orthopaedic and sports medicine and to help my future patients the same way Dr. Cole and his team helped me.”

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Coming Back From: Shoulder Separation

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points: 

  • A “shoulder separation” is a different injury than a shoulder dislocation
  • The shoulder separation involves a sprain to the ligaments of a joint at the point of the shoulder near the end of the collarbone
  • We will often see these injuries when a player is tackled or falls to the ground on the point of the shoulder, with the arm at the player’s side
  • Most shoulder separations from sports injuries can successfully be treated without surgery

This week I’ll offer up some pre-World Cup injury recovery info, inspired by Egypt/Liverpool brilliant playmaker Mo Salah. There’s been much speculation about the nature of Salah’s recent shoulder injury, and I haven’t been able to find a clear diagnosis in publicly available sources. But if I had to guess (and this is a pure guess), given the way the injury occurred and the evaluation from the physician in the accompanying photo, I’d say he likely sustained a shoulder separation.

First, let’s look at some confusing terminology.

I’ve written previously about shoulder dislocation, a serious condition in which the ball portion of the shoulder (humerus) becomes completely dislodged from the socket. This week we’ll discuss a shoulder separation, another common shoulder injury.

A separated shoulder refers to an injury to the ligaments of the acromioclavicular joint (commonly known as the AC joint), which is the joint between the end of your collarbone and the upper part of your shoulder blade. It’s located near the point of the shoulder.

Most shoulder separations occur during some type of hard fall or contact, such as a player being tackled on to his shoulder, or a cyclist falling and landing on his shoulder. When I see a hard fall to the ground I’ll be suspicious for either a shoulder separation or a broken collarbone if the athlete fell with the arm tucked in to the side, and I’m suspicious for a shoulder dislocation if the athlete fell on to the outstretched hand.

There are six types of shoulder separations. Types 1 and 2 are the most common ones we see in sports injuries and are treated without surgery. Type 3 injuries are also reasonably common, and most of these are treated without surgery (although there is some debate about early repair for the throwing shoulder of an elite athlete…).  Types 4-6 are not seen very often in sports injuries and these will require surgery. I refer to these as “types” although some surgeons will call these “grades”.

  • Type 1 – The ligaments have a mild sprain without a tear.
  • Type 2 – The AC ligament tears, leading to a partial separation.
  • Type 3 – The AC ligament and other associated ligaments tear, leading to a complete separation.
  • Types 4-6 – These are complete separations, serious injuries often requiring urgent surgery. I have seen one type 4 separation in a D1 quarterback during my 23-year career.

Here are typical return to play times for the common types:

  • Type 1:You can usually return to play 2-3 weeks after the injury, depending on your sport and position. You should be comfortable, with full motion, normal strength, and ability to do sport specific motions. Treatment includes rest and anti-inflammatory medication.
  • Types 2 and 3:A Type 2 injury takes about 3-4 weeks to fully heal, and a type 3 injury takes about six to eight weeks to heal. We’ll almost always treat these without surgery, and we’ll use the same return to play criteria as indicated above for the Type 1 injury. If you’re in a collision sport (such as football) I’ll usually recommend you return to play with an AC joint pad to minimize the chance of another injury.Logo

Whether Salah will play is still speculative but most media reports indicate him as “probable”. When it comes time to lacing up the cleats for a possibly once-in-a-lifetime event with the eyes of the country on him, my guess is that he’ll find a way to work his magic from game 1.

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Start ACL Injury Prevention Programs When The Players Are Young

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • The FIFA 11 injury prevention warmup program has been proven effective in reducing lower extremity injury rates in soccer players
  • Pre-adolescent and adolescent female players are at particular risk for ACL injury, possibly due to risky movement patterns
  • A recent study shows that the pre-adolescent group may benefit most from training with the FIFA 11 program, although all groups show improvements in their movement patterns
  • This study suggests that starting the FIFA 11 program as early as possible would be beneficial

I’ve written and spoken about how much I believe in the value of the FIFA 11 program to reduce ACL and lower extremity injury rates, and make better soccer players. In fact the value of the FIFA 11 has been demonstrated in other sports too. I honestly can’t see why any coach wouldn’t implement this program. It’s part of the regular warmup you’d be doing anyway, and it’s better for your players. Please do it.

ACL tears tend to happen more frequently in teenagers rather than in younger players. Does that mean you should wait until the players are teenagers to start the FIFA 11? This recently published study suggests that the younger players will have greater improvements in body mechanics than the teenagers. The key study result: start the FIFA 11 program in the younger age groups.

This study was recently published in the American Journal of Sports Medicine. In the study, the authors investigated improvement in movement patterns and mechanics in two groups of young players from an 8-week FIFA 11 training program. They had one age group of female soccer players aged 10-12 and another group of female players aged 14-18. In each age grouping there were “intervention” players who participated in FIFA 11 and “control” who did not.  To be clear, this study evaluated the improvements in movement patterns and did not follow the players out to see whether they had reduced injury rates.

Some movement patterns have been shown to be particularly risky for possible ACL tear or lower extremity injuries. For example, landing in a “knock kneed” position is a risky pattern, as is landing with the knee fully extended. The study authors found that the preadolescent 10-12 year old age group started off with more of the high risk injury patterns than the older players. And the younger players had greater improvements in their movement patterns after the 8-week training.

I spoke with study author Dr. Jason Dragoo, who is one of my practice partners at LogoStanford orthopedic surgery. “A few earlier studies suggested that intervention training programs might have a greater effect on athletes classified as ‘‘high risk’’ for ACL injury (meaning that they had poor movement techniques to start with) as compared with those classified as ‘‘low risk.’’ What we found is that preadolescent athletes not only display riskier movement patterns than adolescent athletes but also benefit more from participation in the FIFA 11 program.  I’d start this as early as you can.”

For More Information:

FIFA 11+ poster ages 13 and up

FIFA kids poster ages 7-12

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