Turf toe refers to an injury to the first metatarsal phalangeal joint or first MTP joint.  This may occur during sports when the great toe catches on the ground and is forced downward into what we would describe as hyper plantar flexion.  When this occurs the capsule and ligaments on the top or dorsal aspect of the joint line or strained or torn.  There could even be an avulsion type chip of bone that is torn or pulled with the ligament.  This also could include any injury to the capsule of the great toe joint in this location.  In general this is different than a sesamoid injury.  Sesamoids are the small bones on the bottom of the great toe joint.

 When the capsule is torn on the first MTP joint, it is a lot like a sprain of an ankle joint ligament or capsule.  The joint can become stiff, swollen and painful.

Just like an ankle injury, the goal is to protect it and allow the capsule to heal.  This is often accomplished with a cast boot.

In addition, with any acute injury icing is helpful initially along with a cast boot and resting.

Therefore any exercise that is done should be nonimpact.  Examples could include aqua jogging.  Another example could include cycling but using the pedal in the arch or even the heel area and avoiding the forefoot.  In general one should wait to do any of these nonimpact exercise until after the acute phase of the initial 3-5 days is over.

 Note that after the initial phase with a cast boot but could vary from 2 weeks to 4 weeks or longer, one can transition to a stable athletic shoe, or hiking boot that has a stiffer forefoot to protect the great toe joint.

Physical therapy may be helpful to reduce swelling and to promote healing. 

 Because the great toe joint is prone to mechanical jamming and long-term arthritis, it is important to treat turf toe aggressively and make certain that symptoms completely resolve.  In addition, to addressing the mechanics of this joint, it is helpful to use a prescription orthotics to offload and protect the joint from mechanical jamming.

And, if the joint has any tendency for stiffness then synthetic joint lubricant such as Supartz or Synvisc is recommended.

Its that time of year again!

We start seeing more patients with foot problems.  Commonly this includes heel pain (which is often plantar fasciitis), forefoot pain which could range from stress fractures, neuroma pain, second MTP joint capsulitis, or even bunion pain.  And a lot of this seems to flare-up when people are wearing flip-flops without any support, worse yet would be walking around on concrete barefoot. By the last month of summer, and sometimes into the fall we start seeing more patients who have suffered from these foot problems.  This is because it so easy to slip on a pair of flip-flops and go to Costco.  But places like Costco are a concrete jungle and you are walking on a hard concrete slab for half an hour or even an hour.  This is very hard on your feet.  Over the weeks and months, as summer progresses this can have a cumulative effect.  And, it can be similar to an overuse injury than athlete would have from running or doing high impact aerobics.

By the time patients come to our clinic for some of these problems, it can be significant enough that we have to do fairly aggressive treatments.  Simple prevention can involve wearing good gym shoes instead of flip-flops when you are going to be on your feet a lot.  Another option would be to wear very good sandals such as the vionic line of sandals.  Some of these even look like flip-flops but they are not to have much more support.

We have a number of different treatment options at our disposal for those people who ended up with this type of "overuse" flip-flop injury. 

Try to remember not go barefoot, instead wear supportive sandals like Vionic or gym shoes.  Wear your flip-flops when you are at the swimming pool but not when you go to Costco!

Take caution when thinking of going barefoot this summer.  Not only should you protect your feet from the sun's harmful rays, but summertime is a primetime for puncture wounds and traumatic injuries to feet and ankles.  The first and best defense to protecting your feet is to always wear shoes when outdoors. 

Puncture Wounds

Nails, shards of glass, slivers of wood, bits of shell at the beach, thorns from bushes, and bumble bees are all hidden dangers lurking in the grass and can easily puncture the skin of your foot.  Even if you have attempted to remove the embedded object, many times dirt and bacteria that were pushed into the wound remain and can cause serious infections.  Any puncture wound that has penetrated the skin should be treated within 24 hours.  Without proper treatment, these type of injuries can result in not only infection, but painful scarring or development of a cyst.

If you are stung by a bee the wound can be treated in the following ways:

• Remove the stinger from the foot.  If you see a little black dot in the wound, part of the stinger is still present.
• Clean the area with soap and water.
• Apply ice or cool water for 10 to 30 minutes to the sting. 
• Consider applying an antiperspirant to the sting.  An ingredient called aluminum chlorohydrate may reduce the effect of the bee venom.
• A lotion such a calamine can be helpful.  A paste of baking soda and water can have a similar effect.
• An antihistamine such as Benedrayl (taken orally) can provide some added relief and help the reaction from spreading.
• Give acetaminophen or ibuprofen for systemic pain relief.

Traumatic Injuries

Accidents happen.  Feet can get caught in the spokes of a bike.  They may be hit by a rock or other objects that flies out from the lawnmower.  Wading in the river can also risk injury to the foot by stepping on a sharp rock.   Sturdy shoes should always be worn when riding bikes or mowing the lawn.  Rubber water shoes or sandals with a thick sole will protect feet in the river.  Any traumatic injury should be evaluated to determine the extent of injury and proper treatment.

Don't let a foot injury ruin your summertime fun - always remember your shoes!

Is it safe to wear high heels while pregnant?  Women and celebrities alike enjoy making a fashion statement in heels and aren't willing to part with them when they are pregnant.  Some even try to balance the extra weight and not topple over in six inch heels. 

Not only does the "pregnant in high heels" appear to look uncomfortable, but some think it is completely absurd and dangerous.  The main concern is the risk of falling and injuring the mother and the unborn baby.  Pregnancy not only adds weight, but also shifts one center of gravity forward (in front of you).  High heels also shift the center of gravity forward and may force women more prone to falls.  Feeling dizzy is common sometimes while pregnant and adding your shifting weight forward in heels may not be the safest way to get around.

Your feet also swell up due to fluid retention especially in the third trimester, and women may have a more difficult time wearing their favorite high heels even after giving birth. 

Easing Swollen Ankles

There are some steps you can take to prevent swollen feet and ankles. These can also help to ease the discomfort if your feet and ankles are feeling swollen already. Try to:

• Avoid standing for long periods
• Wear comfortable shoes – avoid tight straps or anything that might pinch if your feet swell
• Put your feet up as much as you can – try to rest for an hour a day with your feet higher than your heart, for example propped up with cushions as you lie on the sofa
• Do the foot exercises described below

You can do foot exercises sitting or standing. They improve blood circulation, reduce swelling in the ankles and prevent cramp in the calf muscles:

• Bend and stretch your foot up and down 30 times 
• Rotate your foot in a circle eight times one way and eight times the other way
• Repeat with the other foot 

The other pregnancy symptom women have to contend with is back aches, joints, and cramps and wearing high heels can make those pains worse.  So it is probably best to make sure you have flatter shoes ready to slip on to avoid increased pain and potentially falling.  

The risk of falling with or without injury exists and pregnant women should consider this before donning a pair of high heels.

It is no surprise that snowboarding has always been about originality, diversity, and entertaining, but does come with inherent dangers.  Snowboarder’s fracture is a rare ankle fracture that is on the rise. 

The fracture involves the positioning of how the snowboarder lands with the foot turned in and toes pulled up toward the head.  The force of the impact is enough to break off the lateral process of the Talus bone – termed Snowboarder’s fracture.  The Talus bone is forced into the heel bone (Calcaneus).  

This type of break is 15 times more common with snowboarders than in the general population. Many times the fractures of the lateral process of the Talus are not diagnosed in the early stages.  Even when x-rays are taken, the fracture cannot always be seen and many times a snowboarder is misdiagnosed as having a severe ankle sprain.  

Common injury signs and symptoms of a snowboarder's ankle are a history of ankle sprains, persistent ankle pain, and persistent swollen ankle. A CT scan should be considered when these symptoms occur for a long duration of time, because the scan will provide the best detail if there is a fracture.

Treatment for Snowboarder's Ankle includes:

• Apply ice packs/cold therapy to reduce swelling
• Protect the foot with a removable plastic cast
• Use a buoyancy aid for pool exercises
• Wear ankle support for protection
• Use a wobble board for strengthening
• Consult with a specialist
• Possible Surgery

Note:  The wobble board, together with the ankle braces are commonly used in the rehabilitation of ankle instability.  Exercising by running in the pool using a buoyancy belt also allows the patient to regain fitness.

Also, some experts believe an increase in talus fractures among snowboarders might be related to the use of a soft boot that, unlike ski boots, aren't stiff enough to adequately protect the ankle from injury during crashes.  So for maximum protection from snowboarder's fracture, your snowboarding boots should allow for some degree of stability, but provide for enough flexibility for movement and balance adjustments.

Identifying that you may have this type of injury as early as possible can help reduce the likelihood of subsequent ankle joint damage.

Owlet is an ankle-worn health tracking device for your baby, with an accompanying app that provides your baby's health "vitals" readout at any time.

The device uses a system called Pulse Oximetry, which has been used in hospitals and pediatrics for years.  The "smart sock" using infrared and red lights tracks a baby's heart rate, oxygen levels, skin temperature and even provides rollover alerts during sleep.

This information can then be transmitted to a smartphone app or you can plug in the smart sock to a USB to see vitals on your computer and/or connect to your home Wifi network to see readouts on any connected device.

The sock's electrical components are housed in a resistant silicone case for safety, and it's wireless, and hypoallergenic.

Not only does Owlet track your baby's health, but offers a peace of mind and comfort to new parents.

For more information, you can go to Owlet's website at Owletcare.com.