How To Treat Turf Toe Injuries

Start Page: 38

What You Should Know About Athletic Shoes And Turf Toe

Coker and Arnold also concluded that football shoes can contribute to turf toe due to fitting issues.3 At the time of their study, most football shoes were sized primarily by length. Athletes who needed wider shoes were in general forced to wear longer shoes that created the potential for excess shoe length in the toe box. This created more of a lever during dorsiflexion of the forefoot, leading to potential turf toe injury.

Nigg and Segesser studied an increase in friction between the fixed forefoot and the artificial turf in turf toe injuries.6 Bowers and Martin wrote another paper commenting on the relationship between the shoe and the surface relationship causes of turf toe.1

Unfortunately, I feel the evaluation test that Bowers and Martin used to determine shoe stiffness was flawed. In their study, the midfoot and posterior aspect of the football shoe was clamped down while researchers tested the flexibility of the forefoot. However, this is a flawed test because the flexibility of many shoes can and will continue into the midfoot portion of a shoe.

The American Academy of Podiatric Sports Medicine utilizes a shoe evaluation process that evaluates both the forefoot and midfoot stiffness of running and athletic shoes as two of the three most prominent components in athletic shoe function. From my perspective as well as the the academy’s perspective, it is important to have some flexibility of the forefoot in a shoe so the MPJs are allowed to pivot in late midstance and early propulsion. Loss of this important portion of the gait cycle can lead to significant negative compensations throughout the foot, ankle and lower extremities.

43
Author(s): 
By Bruce E. Williams, DPM

Turf toe is primarily considered a sprain of the first metatarsophalangeal joint (MPJ). The mechanism of turf toe injuries is a hyperextension of the first MPJ, which results in a sprain of the plantar joint capsule or a potential tear or rupture of the plantar capsule and ligaments.
   Common forefoot injuries similar in presentation to turf toe are non-specific trauma, Freiberg’s infraction, sesamoiditis, arthritis and soft tissue injury.
   According to Bowers and Martin, the advent of artificial grass or turf, and softer, more pliable football shoes in the late 1960s and early 1970s seemed to lead to an increased incidence of a hyperextension injury of the first MPJ.1 Bowers and Martin first termed turf toe during their participation with the West Virginia University football team. In their initial paper, they stated that they had never before seen such an injury. Yet after the university switched to artificial turf, they saw an incidence of 5.4 injuries a year from 1970 to 1974. We see turf toe injuries in many sports now but they are historically identified with football due to this initial paper.
   In general, the turf toe injury occurs when a player lands or falls on the back of the lower leg of another player whose foot is plantarflexed at the ankle while the great toe is fully extended. This creates a hyperextension injury. Hyperflexion has been associated with turf toe as well though it is more commonly called “sand toe” as referenced in an article by Frey and Anderson.2
   Hyperflexion of the first MPJ occurs less commonly. These injuries may occur when a ball carrier gets tackled from behind and his knee is pushed forward while the foot is plantarflexed and the body continues moving over the fixed plantarflexed foot.
   Finally, a valgus or varus injury of the first MPJ occasionally occurs in players. A strenuous push-off has been related to a sprain of the first MPJ. Coker and Arnold saw this mechanism of injury occurring because of a chronic problem in the first MPJ. They felt that pes planus may increase the stress on the medial aspect of the foot and predispose players to a valgus mechanism of injury.3
   Roukis and Scherer concurred when they described the exact mechanism involved whereby a decrease in first MPJ dorsiflexion, coupled with an increase in first ray dorsiflexion and/or abduction, will result in hallux abducto valgus and or hallux rigidus deformity. Therefore, this may predispose some athletes to chronic medial capsular or ligamentous sprains of the first MPJ, or traumatic hallux abducto valgus.4

image description image description 




  


  
Post new comment


  



 
 




 
 




 
 



  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
More information about formatting options






 
 3 + 2 =  
 
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.