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Turf Toe

Turf toe gets no respect. Let's take a closer look at the causes of turf toe and see how to treat it more effectively. Turf toe is actually a form of hallux limitus. Hallux limitus is classically described as pain and progressive decrease in the range of motion of the first metatarsal phalangeal joint (MPJ). The onset of hallux limitus is due to the following:


Gout Gout is a form of arthritis that occurs suddenly, usually affecting the big toe, and causes severe painful attacks, tenderness and redness in the affected joint. An attack can last days or weeks. Gout is caused by a build up of uric acid which turns into uric acid crystals that are deposited into the joints causing them to become inflamed. The first attack of gout often occurs late at night.


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 Joint pain is a common symptom with many possible causes. There are many possible causes of joint pain. The causes can be divided into categories:

Sometimes, even if a person lives a healthy lifestyle, abstains from alcohol or drinks it modestly, they can experience a condition that mirrors gout, but is in actuality, a different arthritic condition altogether known as pseudogout. To help you understand the differences between these two, the following is a breakdown of the causes, symptoms and treatments for each condition.

Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

But before we go any further, we need to understand that the terms turf toe and hallux limitus aren't really synonymous. The fundamental difference between the two terms is the patient population that they affect. Turf toe is a term used in athletic circles referring to any injury of the great toe joint. Consequently, discussions about turf toe will focus on the first two causes of hallux limitus mentioned above; functional hallux limitus and direct physical injury. On the other hand, when we discuss hallux limitus, we're actually referring to a broader, 'non-athletic' patient population and need to include all three causes of hallux limitus.

Other causes are also possible. In some cases, no cause can be found. Symptoms: - Involuntary weight loss of 10 pounds or more, - The joint pain persists beyond 3 days, - Severe, unexplained joint pain especially if accompanied by other unexplained symptoms,

Left untreated can cause permanent joint gout and kidney damage. You can treat gout with drugs. The first line of treatment should be pain relief. NSAIDs may control inflammation and pain in patients with gout. NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), as well as the most powerful prescription NSAIDs. Corticosteroids, such as prednisone, given in short courses, are powerful anti-inflammatory agents for the treatment of acute gout. The ice can be applied for 20-30 minutes several times a day. Weight reduction may help to lower the risk of recurrent attacks of gout. The best solution is to reduce dietary fat and calorie intake combined with a programme of regular aerobic exercise. Alcohol consumption should be reduced or stopped.

Eighty percent of all US population suffer from back pain at some point in their lives. In spite of this common occurrence, most people are completely unaware of the things they do that contribute to this problem.


Anatomy: The great toe joint, or first metatarsal joint consists of two bones. The proximal bone is the first metatarsal and the distal is called the proximal phalanx or hallux. These two bone move against each other in an up and down motion through what we refer to as the sagital plane. Biomechanics: The motion of the great toe joint is dependant upon the plantarflexion of the first metatasal. If the first metatarsal is limitied in its' ability to plantarflex, the joint will jam resulting in funtional hallux limitus, which as we know is one of the causes of turf toe.

4. Applying heat helps relax aching muscles, and reduces joint pain and soreness. 5. Applying cold helps to lessen the pain and swelling in a joint.

Other conditions - synovitis, crystal deposition diseases such as gout, systemic arthritis, external physical influences such as Dupytren's contracture, etc.

Causes: Low back pain is usually caused by strain from lifting, twisting, or bending. However, some low back pain can be a symptom of a more serious condition, such as an infection, a rheumatic or arthritic condition, or ovarian cysts. Today, a high proportion of people spend the better part of their working day sitting at desks, at work stations, or in cars and trucks. These changes in human behavior have had a profound-and largely negative- impact on human physiology.

References: Lombardi, C.M., Silhanek, A.D., Connolly, F.G., Dennis, L.N., Keslonsky, A.J. First Metatarsophalangeal Arthrodesis for Treatment of Hallux Rigidus: A Retrospective Study. J. Foot Surg. 40:3, 137-143, 2001

Ronconi, P., Monachino, P., Baleanu, P.M.,Favilli, G. Distal Oblique Osteotomy of the First Metatarsal for the Correction of Hallux Limitus and Rigidus Deformity. J. Foot Surg. 39:3, 154-160, 2000

Nomenclature: First MPJ - the big toe joint Metatarsus primus elevatus - a functional or structural position of the first metatarsal First metatarsal - the foot bone making up the proximal portion of the big toe joint Hallux - the great toe

6. Vitamin C, taken in high doses, can help decrease blood uric acid levels.


7 NSAIDS such as indomethacin (Indocin) and naproxen (Naprosyn) are effective anti-inflammatory medications for acute gout.

What's the actual physical change that takes place in the joint with turf toe? As an easy analogy, consider the changes that takes place when an apple falls from a height and is damaged. The skin of the apple appears intact but the underlying pulp is damaged. In the case of turf toe (hallux limitus), think of the skin of the apple as the cartilage of the joint and the damaged pulp of the apple is the subchondral bone. Mild cases of turf toe (hallux limitus), result in little damage to the subchondral bone and will merely exhibit signs of inflammatory change within the joint. Most authors would refer to these cases as stage one turf toe (hallux limitus). More severe cases result in damage to the joint surface, the subchondral bone or both. These are the stage two and three cases of turf toe (hallux limitus) that show visible change on x-ray. As the subchondral bone becomes increasingly damaged, it will create an uneven supporting surface for the cartilage. An increase in activity results in uneven loading of the joint due to the compression injury of the subchondral bone.

Is the onset of turf toe always the same? Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step.

These conditions result from materials being deposited into the joints, infections of the joint, sometimes called septic arthritis. autoimmune disorders, in which a person's body produces antibodies against its own tissues. These disorders include rheumatoid arthritis and systemic lupus erythematosus.

Treatment of turf toe varies with the type of healthcare provider and includes the use of rest, shoe modifications, orthotics, steroid injections and surgery. The success of non-surgical care will vary with the degree of injury, the rate at which the injury is healing and how much osteoarthritis has occurred. We see varying degrees of success with orthotics that promote plantarflexion of the first ray, effectively treating metatarsus primus elevatus and peroneus longus dysfunction. Simple arch supports can make a significant difference in the symptoms of turf toe. Should our patient not respond to conservative care in a reasonable time period, we are not reluctant to suggest surgical revision to address the problem whether it be revisions of the joint defect, shortening of a long first metatarsal or structural revision of metatarsus primus elevatus. As mentioned before, the clinical appearance of dorsal lipping or visible radiographic changes are suggestive of moderately advanced osteoarthritis, a condition that is only repaired by joint revision or replacement.

 
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When treating turf toe be sure to recognize the fact that there is no nerve innervation in articular cartilage. Pain associated with stage one turf toe (hallux limitus) is either synovial pain or bone pain. If we recognize that painful stage one turf toe (hallux limitus) may be due to bone pain, we then realize that turf toe should be treated aggressively to insure the long term viability of the joint.

More Details about joint pain, back pain, herbal remedies, here.

Visit: http://www.ayurvediccure.com

About the author:
Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle
surgeon. Dr. Oster is also board certified in pedorthics. Dr.
Oster is medical director of href=http://www.myfootshop.comMyfootshop.com and is
in active practice in Granville, Ohio.

Think of turf toe (hallux limitus) as an isolated case of osteoarthritis limited to the first MPJ. Whether the injury is acute or due to repetitive loading, the result is a load that is applied to the subchondral bone that is greater than what the bone can tolerate. As the injury progresses, a series of micro fractures will develop in the subchondral bone. The typical soft spongy character of the metaphyseal bone changes to become brittle and hard. The result is that the articular cartilage looses its' underlying support and becomes susceptible to damage. Juxtachondral eburnation, osteophytes, lipping, spurring; call them what you like, but what you see on your x-ray is the slow progressive destruction of the joint.

Functional hallux limitus - biomechanical function that results in metatarsus primus elevatus and subsequent repetitive jamming of the first MPJ. Direct physical injury - injury to the articular cartilage or subchondral bone. These injuries may be due impaction injuries or hyperextension/flexion of the first MPJ.

Back pain can be: Acute, lasting less than 3 months. Most people gain relief after 4 to 6 weeks of home treatment. Recurrent, a repeat episode of acute symptoms. Most people have at least one episode of recurrent low back pain. Chronic, lasting longer than 3 months.


Symptoms: Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step. Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

Effective and Proven Natural Remedies: Rub the painful area of the joints with Arthcare oil. This is very effective for relieving the pain. Vata and pitta types should just rub the oil on the surface, while kapha types should give a deeper massage to the area for some time. Read More on Massage Therapy and Benefits

Low Back problems affect the spine's flexibility, stability, and strength, which can cause pain, discomfort, and stiffness. Low back pain is often triggered by some combination of overuse, muscle strain, or injury to the muscles and ligaments that support the spine. Less commonly, low back pain is caused by illness or spinal deformity.

Gout Treatment and Prevention Tips 1. Drinking alcohol should be reduced or stopped. 2. Try to keep your weight down. 3. Use helpful devices such as a cart to carry your grocery bags.

Arthcare Oil and Arthcare Capsules: Arthcare is a Muscle relaxant , Anti-inflammatory Herbal Massage Oil - the best natural solution for Joint Pains and Back Problems, manufactured under the guidance of renowned MD Ayurveda Specialist doctors.


Differential Diagnosis: The differential diagnosis of turf toe includes; Arthitis Fracture Gout Joint infection Joint or bone tumor Synovitis

Gout is sometimes called the "disease of kings" because it has long been associated with the wrong kind of excess in food and wine, only the rich and powerful could afford. Gout is one of the most common forms of arthritis (inflammation). Gout is the state resulting from uric acid crystals in the filing of body tissues. Gout is characterized by an overload of uric acid in the body and recurring attacks of inflammation (arthritis). The chronic gout can lead to hard nodule deposits of uric acid in and around the joints, decreased renal function and kidney stones. Gout affects about 1 in 100 people and less than 6 to 7 per cent of older men. Men are more likely to find that women are the drop, but women are becoming more sensitive to the drop after menopause.

It occurs more frequently in countries that have a high standard of living. Mostly male over the age of 40. Gout affects up to 500000 (1 to 30) of Canadians. Gout attacks usually the big toe (about 75 percent of initial attacks), but it can also affect other joints such as the ankle, heel, foot, knee, wrist, elbow, fingers, and the spine. The most common sign of gout is a nighttime attack of the swelling, tenderness, redness and pain in your big toe. Gout is strongly associated with obesity, hypertension, hyperlipidemia, and diabetes. Due to genetic factors, the drop tends to run in some families. Gout can be inherited or occur as a complication of another condition. The use of thiazide diuretics used to treat high blood pressure and low dose aspirin may also raise levels of uric acid.

Unger, K., Rahimi, F., Bareither, D., Muehleman, C. The Relationship Between Articular Cartilage Degeneration and Bone Changes of the First Metatarsophalangeal Joint. J. Foot Surg. 39:1 24-33, 2000

It is now believed that the leading cause of back pain is simple muscle strain. Symptoms may come on suddenly and can be acutely painful; but back pain, in actuality, develops over a long period of time. When muscles contract, lactic acid and pyruvic acid are produced as byproducts of muscular activity. It is the lactic acid in the muscles that produces the sensation of muscle fatigue following strenuous activity. If high levels of these acidic byproducts accumulate in the muscles, they cause irritation that can eventually turn into pain and interfere with the normal conduction of electrical impulses in the muscle tissue. This results in a phenomenon called delayed-onset muscle soreness (DOMS). Problems with acidic buildup are often made worse by dehydration.

wear-and-tear, such as from overuse, injury, or osteoarthritis. Osteoarthritis is the most common form of arthritis, or joint inflammation, conditions that affect metabolism, such as gout and pseudo gout.


A build up of uric acid that develops into gout can result from:


 
 
     
 
 





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