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Soul: "Keep going bitch" said to myself in different accents.

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We do not talk about the instrumentals enough like good god they're amazing

[pivotalmotion]

Turf toe and Treatment

What You Should Know About Turf Toe Bowers and Martin introduced the term “turf toe” into the literature in 1976 to include soft tissue hyperextension injuries in athletes.15 Although we have grouped these injuries under the general heading of turf toe, they represent a number of different injuries from mild to severe around all the structures of the first metatarsophalangeal joint (MPJ).

The incidence of turf toe injuries is difficult to quantify.16 However, turf toe injuries rank third behind knee and ankle injuries at major universities.17 While researchers coined the term turf toe with the advent of artificial turf, these injuries do not solely occur on artificial turf.16 In one study involving the University of Arkansas football team, ankle injuries were more prevalent than first MPJ injuries. However, the first MPJ injuries were more severe, accounting for a disproportionate number of missed practices.18

The most common mechanism of turf toe injury is usually pure hyperextension of the plantar capsule of the first MPJ.18 To diagnose the structures involved, a knowledge of the functional requirements of the great toe during athletics is necessary. As an athlete rises on the ball of the foot to initiate activities such as jumping, blocking or running, the hallux dorsiflexes at the MPJ upward of 100 degrees. As the proximal phalanx extends, the sesamoids move distally and the articular surface of the dorsal aspect of the metatarsal head bears most of the load. In the progression of forward motion at the first MPJ, the plantar complex attenuates or ruptures, leading to unrestricted dorsiflexion at the joint. This can lead anywhere from partial tearing of the plantar structures to frank dislocation.

In addition to pure hyperextension injury, combined mechanisms occur and depend on the position of the first MPJ and the associated forces applied to the hallux at the time of injury. An injury to the medial plantar structures caused by a valgus directed force is more common than injury to the plantar lateral structures caused by varus directed forces.19,20 The turf toe type injuries can increase in severity in the presence of excessive foot pronation because of the hypermobility and the lack of stability when the foot hits the ground, thereby allowing a further amount of abnormal dorsiflexion to occur at the first MPJ.

A Guide To The Etiology And Classification Of Turf Toe We generally accept that the two most common etiologic factors of first MPJ turf toe-type injuries are the playing surface and footwear flexibility. It is likely the athlete at the greatest risk for sustaining injury is the one who participates in cutting or pivoting with lightweight flexible cleats on synthetic turf or hard playing surfaces.16

Researchers have classified first MPJ acute injuries into three general categories.20 In evaluating these injuries, the clinician must keep in mind there are many variations to the injury. A comprehensive and accurate history is always critical. On-field observations are the most helpful. Reviewing game tape video will provide keys to the real mechanism of injury that occurred. Hopefully, this will be available to you to improve your assessment.

In the actual examination, one should note the presence of ecchymosis and edema, paying attention to the location. Perform palpation of the joint surfaces of the first MPJ. Assess the comparative joint range of motion bilaterally. Assess abnormalities such as a mechanical block from interposed soft tissue entrapment, hypermobility resulting from a plantar plate or complete capsular tear as well as joint instability.16 Perform varus and valgus stress testing as well as the Lachman test (dorsoplantar drawer test) and compare the test results to the uninjured side. This can help you assess the plantar capsular ligament complex. Resistance examination of the first MPJ can help you evaluate long flexor and long extensor strengths.

Pertinent Treatment Insights On Turf Toe When treating turf toe, first evaluate the patient’s foot structure as well as shoe and cleat wear, and then make the proper adjustments. One can work with the athlete to improve Achilles, calf and peroneal flexibility, if necessary, in order to increase dorsiflexion through stretching, foam roll and the Graston Technique®. If the condition is chronic, use the Graston technique and joint mobilization to break up joint adhesions and improve range of motion in the ankle and toe joints.

Intrinsic muscle exercise and foot and toe exercises can help improve function. Exercises include picking up marbles with the toes, toe crunches and towel curls. Control the pain and inflammation with deep icing of the joint along with compression and electrical stimulation. For athletic activity, a “turf toe” tape job can help with function and decrease the chances of irritation.

References

   Edgeworth Economics. Dangers of the Game: Injuries in the NFL. Available athttp://www.edgewortheconomics.com/files/documents/NFL_Season_2011_Statis… .

   Breslow JM. For the NFL, focus on concussions yields mixed results. Frontline: The Concussion Watch. PBS, 2013. Available at www.pbs.org/wgbh/frontline/article/about-concussion-watch-2/ .

   Aquino A, Payne C. Function of the plantar fascia. Foot. 1999; 9(2):73–78.

   Barton CJ, Bonanno DR, Carr J, et al. Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesized with expert opinion. Br J Sports Med. 2016; 50(9):513–526.

   Hreljac A, Ferber R. A biomechanical perspective of predicting injury risk in running. Int Sport Med J. 2006; 7(2):98–108.

   Romanov N. The Pose Method of Running. Pose Tech Press, 2002.

   Robert DD. Prevention and Treatment of Running Injuries. Slack Incorporated, Thorofare, NJ, 1989.

   Chandler TJ, Kibler WB. A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis. Sports Medicine. 1993; 15(5):344–352.

   Cornwall MW, McPoil TG. Plantar fasciitis: etiology and treatment. J Orthop Sports Phys Ther.1999; 29(12):756–760.

   Kwong PK, Kay D, Voner RT, White MW. Plantar fasciitis. Mechanics and pathomechanics of treatment. Clin Sports Med. 1988; 7(1):119–126.

   Thordarson DB, Schmotzer H, Chon J, Peters J. Dynamic support of the human longitudinal arch: a biomechanical evaluation. Clin Orthop Relat Res. 1995; 316:165–172.

   Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. J Athl Train. 2004; 39(1):77.

   Tupa VV, Chistjakov C, Aleshinskyi A, et al. Sprint – biomechanics of push off. Light Athletics. 1981; 9(1):10–12.

   Romanov N, Fletcher G. Runners do not push off the ground but fall forwards via a gravitational torque. Sports Biomech. 2007; 6(3):434–52.

   Bowers KD Jr., Martin RB. Turf-toe: a shoe-surface related football injury. Med Sci Sports. 1975; 8(2):81–83.

   Baxter DE, Porter DA, Schon L. Baxter’s the Foot and Ankle in Sport. Mosby Elsevier, Philadelphia, 2008.

   Clanton TO, Ford JJ. Turf toe injury. Clin Sports Med. 1994; 13(4):731–741.

   Coker TP, Arnold JA, Weber DL. Traumatic lesions of the metatarsophalangeal joint of the great toe in athletes. Am J Sports Med. 1978; 6(6):326-334.

   Anderson RB. Turf toe injuries of the hallux metatarsophalangeal joint. Tech Foot Ankle Surg. 2002; 1(2):102–111.

   Watson TS, Anderson RB, Davis WH. Periarticular injuries to the hallux metatarsophalangeal joint in athletes. Foot Ankle Clin. 2000; 5(3):687–713.

   Kingma JJ, de Knikker R, Wittink HM, Takken T. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med. 2007; 41(6):e3–e3.

   Park DY, Chou L. Stretching for prevention of Achilles tendon injuries: a review of the literature.Foot Ankle Int. 2006; 27(12):1086–1095.

   Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med. 1984; 12(3):179–184.

   Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. Am J Sports Med. 2002; 30(2):287–305.

   Hess GW. Achilles tendon rupture: a review of etiology, population, anatomy, risk factors, and injury prevention. Foot Ankle Spec. 2009; 3(1):29–32.

   Freedman BR, Gordon JA, Soslowsky LJ. The Achilles tendon: fundamental properties and mechanisms governing healing. Muscles Ligaments Tendons J. 2014; 4(2):245–255.

   Finch CF. No longer lost in translation: the art and science of sports injury prevention implementation research. Br J Sports Med. 2011;45(16):1253–1257.

   Hulme A, Finch CF. From monocausality to systems thinking: a complementary and alternative conceptual approach for better understanding the development and prevention of sports injury.Injury Epidemiology. 2015; 2(1):31.

   Helmhout PH, Diebal AR. The effectiveness of a six-week intervention program aimed at modifying running style in patients with chronic exertional compartment syndrome. Results from a series of case studies. Orthop Sports Med. 2015; 3(3):2325967115575691.

If foot pain is an issue for you and you live in Newmarket, Ashgrove or Herston & need help contact Pivotal Motion Podiatry today on 07 33525116

http://www.pivotalmotionpodiatry.com.au/turf-toe-and-treatment/