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PMR Clinic Sports Medicine and Orthopedic

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

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PMR Clinic Sports Medicine and Orthopedic

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  1. PMR Clinic • Sports Medicine and Orthopedic

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

  3. Turf Toe

  4. 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

  5. Painful Great Toe What is the dx?

  6. Sand Toe

  7. How do you grades turf toes ?

  8. 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)

  9. 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

  10. What is the etiology?

  11. 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

  12. What is a Tennis Toe ?

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

  14. Subungual hematoma

  15. What is a fetlock?

  16. MTPJ of horses Why is it important?

  17. Do Sesamoidfx’s occur frequentlyin Turf Toe?

  18. Rarely

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

  20. Knee, Ankle and Turf Toe

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

  22. 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

  23. Name some treatment options

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

  25. Would you recommend surgery?

  26. Surgery • Sesamidfx • Separation of the bipartite sesamiod bone • Instability hallux rigidus • Loose body

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

  28. 50 % have persistent symptoms after 5 years

  29. Name some Long term problems?

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

  31. 12 weeks later still having toe swelling“Lawyer”

  32. Picture in you clinic?

  33. 100 Dollar Hint?

  34. Podagna?

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

  36. What was the predisposing factors?

  37. TraumaHigh meat consumption

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