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Turf Toe Injuries
Activities such as football, basketball,
soccer, field hockey and lacrosse show the high incidence of injury to
the great toe joint on artificial surfaces. Other non-sporting causes
include change in shoe gear, limited range of motion of the great toe
joint, and sometimes flat foot conditions. Mechanism of Injury There
are two mechanisms of injury for turf toe. The most common cause is
hyperextension of the great toe joint. The great toe joint is
hyper-extended as the heel is raised off the ground. An external force
is placed on the great toe and the soft tissue structures that support
the great toe on the top are torn or ruptured. Physical Signs and Symptoms Symptoms
of acute injury include pain, tenderness and swelling of the great toe
joint. Often there is a sudden acute onset of pain during push-off
phase of running. Usually, the pain is not enough to keep the athlete
from physical activities or finishing a game. This causes further
injury to the great toe and will dramatically increase the healing time. Injuries to the great toe that cause turf toe are graded into three categories. A
Grade I turf toe injury is considered to be mild and the supporting
soft tissue structure that encompass the great toe are only sprained or
stretched. This is the most common type of injury. There is minimal
swelling with mild local tenderness and usually no black and blue
bruising evident. Grade II turf toe injuries are
considered moderate in severity. They present with more diffuse
tenderness, swelling, restricted range of motion and usually are mildly
black and blue in appearance. There is usually a partial tear of the
supporting ligaments but no articular cartilage damage. Grade
III injuries are considered severe in nature because of the
considerable swelling, pain on palpation, restriction of range of
motion, inability to bear any weight on the injured foot and diffuse
black-and-blue appearance of the great toe. There is generally tears to
the joint capsule, ruptured, ligaments and possibly compression damage
to the articular cartilage of the great toe. Treatment Treatment
is usually centered on an individual basis and the severity of the
injury sustained. The following are general principle guidelines for
turf toe injuries. The mnemonic "RICE" can be employed. The "R" stands
for rest and is the hallmark component to allow for successful healing
to occur. However, this is the greatest area of noncompliance because
the athlete assumes the injury to be trivial and not severe enough to
miss a game or practice. The "I" represents ice, which is usually
performed for the first 48-72 hours after the initial injury.
Cryotherapy consists of placing the injured toe in a bucket of ice
water for 15-20 minute intervals. "C" signifies compression, which is
done by taping the great toe in a compression dressing or strapping.
The "E" stands for equipment modification or change. For example, the
use of a stiffer athletic shoe to resist motion of the great toe or the
insertion of an orthotic to increase the support of the great toe..
Additionally, strapping of the great toe to limit motion may allow a
highly competitive athlete to return to activities quicker.
Non-steroidal anti-inflammatory drugs (NSAID) may be utilized for
relief of minor pain as well as to decrease the inflammation of the
injury. Grade I injuries do well with strapping
and usually only require a few days of rest. Grade II injuries should
adhere to the "RICE" principles above and usually require one to two
weeks of missed practices and games. Grade III injuries are more severe
injuries and the healing process may take four to six weeks of recovery
time from physical activities. Sometimes, Grade III turf toe injuries
do not heal appropriately with conservative care and result in chronic
pain and instability. Surgical reconstruction of the joint capsule,
ligaments and articular cartilage may be necessary to restore proper
alignment and function in these extreme cases.
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