PMR Clinic Sports Medicine and Orthopedic. Limps with painful great toe What is the dx?

• PMR Clinic

• Sports Medicine and Orthopedic

Limps with painful great toe

What is the dx?

Turf Toe

• Hyperdorsiflexion injury• Axial load foot flexed in equinus• 1st metetarsaophalangeal joint dorsiflexion

injury• Tears the plantar plate complex• Severe compression of the articular of the

metatarsal head along with separation of the sesamoid component

Painful Great Toe What is the dx?

Sand Toe

How do you grades turf toes ?

• 1 – stretch or minor tearing of capsuloligamentous complex

• 2 – Partial tear without involvement of the articular surface

• 3 - Complete tear, tear of the plantar plate (sesamoid fracture)

• Grade 1 Injury - localize tenderness

• Grade 2 Injury – More widespread tenderness and swelling and ecchymosis

• Grade 3 Injury – Severe diffuse tenderness and swelling painful ROM

What is the etiology?

• Footwear – absence of a stiff sole place

• Synthetic surfaces

• Ankle ROM – the greater of the ankle rom correlates with risk of hyper extension of the MTP

What is a Tennis Toe ?

• Repeated trauma of the longest toe against the inside of the toe box of shoe leads to bleeding under the nail

Subungual hematoma

What is a fetlock?

MTPJ of horses

Why is it important?

Do Sesamoid fx’s occur frequentlyin Turf Toe?

Rarely

The three most common causes of missing playing time?

Knee, Ankle and Turf Toe

How much weight does the great toe bear in walking?

Twice the weight of the other toes, gait up to 40 to 60 % of the body weight and up to 8 times the body weight when jumping

Name some treatment options

Six weeks of therapy toe still swollen and painful to walk

Would you recommend surgery?

Surgery

• Sesamid fx• Separation of the bipartite sesamiod bone• Instability hallux rigidus• Loose body

What is the Long Term Sequelae of Turf Toe ?

•50 % have persistent symptoms after 5 years

Name some Long term problems?

Functional Limitations

• Hallux rigidus• Hallux valgus• No push off strength• Running and pushing off compromise

12 weeks later still having toe swelling“Lawyer”

Picture in you clinic?

100 Dollar Hint?

Podagna?

Do Not forget your medicineit is uric acid crystals (Gout)

What was the predisposing factors?

TraumaHigh meat consumption