Turf Toe

September 14, 2010
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With the advent of football season starting this past weekend, I thought it appropriate that we try to “tackle” common injuries suffered during the season.  As some of you may know, when players in the NFL are injured it completely messes up our Fantasy Football seasons and we quickly scramble to pick up “free agents.”  Aside from our frustrations, however, it’s the players who are suffering from ankle injuries, muscle sprains, tendonitis and so forth.  Understanding some of their conditions might provide us with a small amount of sympathy for the ridiculous amount of money they’re making to sit on the sidelines!

Professional athletes are considered to be in tip-top shape compared to the average citizen, and many people wonder how, being in such great shape, they still manage to injure themselves.  I can assure you, although some injuries occur secondary to poor preparation most occur secondary to over-use, direct impact, or abnormal force vectors through the body.

This week I would like to discuss Turf Toe.  It seems like an ambiguous diagnosis, but it is a real diagnosis with those most frequently afflicted being athletes that play on turf surfaces.   The actual injury is a disruption of the plantar ligaments (those underneath) the big toe secondary to hyperextension, or excessive bending of the toe upwards in relation to the foot.

The injury occurs when the athlete’s cleat gets ‘stuck’ in the turf surface while the body is moving in a forward direction.  This motion forces the big toe to extend, abnormally, before the cleat can release itself from the surface.  This hyperextension can induce an overstretching of the plantar ligaments, a partial tear, a complete tear, and even cause damage to the big toe joint if it becomes compressed during the injury.  Almost immediately pain becomes evident to the player, but professional athletes tend to play through pain until it’s absolutely unbearable.  However, this pain is usually accompanied by swelling and difficulty in bending the toe, realized when the athlete removes his or her cleat after a game.

The tenants of any injury apply to treating Turf Toe: RIICE: Rest, Ice, Immobilization, Compression and Elevation.  Rest and Immobilization will prevent further injury to the plantar ligaments in addition to giving them a chance to repair themselves.  Ice, compression bandaging of the toe and elevation will help decrease swelling and subsequently decrease pain to the joint. Of course, non-steroidal anti-inflammatory drugs such as Ibuprofen can be utilized to decrease pain and help control inflammation as well.  Athletes are typically encouraged to keep off their toe/foot for at least 3 days, after which partial weight bearing in a rigid soled shoe, to prevent motion at the joint, can be attempted

It is always wise, when a Turf Toe injury is possible, to be evaluated by a Podiatrist.  X-rays can help rule out damage to the joint and physical therapy will help get the athlete back to their game in no time!  It is likely that with return to activity, protection of the toe will be exercised through taping and shoe accommodations to keep motion to a minimum.   Obviously, depending on the extent of damage, more time away from the game may be necessary to allow for adequate healing, but at the professional level, those athletes are looking at a maximum of three weeks on the sidelines.  Too early a return to activity can lead to further damages to the joint, including arthritis and eventual loss of motion, so caution should always be exercised!

Next week, I’ll be discussing muscle pulls and tears including those most commonly suffered in professional athlete: the hamstring, and achilles tendon.

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