1. PMR Clinic Sports Medicine and Orthopedic

5. Limps with painful great toe What is the dx?

6. Turf Toe

9. 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

11. Painful Great Toe What is the dx?

12. Sand Toe

13. How do you grades turf toes ?

14. 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)

15. 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

16. What is the etiology?

17. 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

18. What is a Tennis Toe ?

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

20. Subungual hematoma

21. What is a fetlock?

22. MTPJ of horses Why is it important?

23. Do Sesamoid fx’s occur frequently in Turf Toe?

24. Rarely

25. The three most common causes of missing playing time?

26. Knee, Ankle and Turf Toe

27. How much weight does the great toe bear in walking?

28. 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

29. Name some treatment options

33. Six weeks of therapy toe still swollen and painful to walk

34. Would you recommend surgery?

35. Surgery Sesamid fx Separation of the bipartite sesamiod bone Instability hallux rigidus Loose body

36. What is the Long Term Sequelae of Turf Toe ?

37. 50 % have persistent symptoms after 5 years

38. Name some Long term problems?

39. Functional Limitations Hallux rigidus Hallux valgus No push off strength Running and pushing off compromise

40. 12 weeks later still having toe swelling “Lawyer”

41. Picture in you clinic?

42. 100 Dollar Hint?

43. Podagna?

44. Do Not forget your medicine it is uric acid crystals (Gout)

45. What was the predisposing factors?

46. Trauma High meat consumption