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Turf Toe? What Is That?
“Turf toe” means that the strong fibrous ligaments connecting your big toe to your foot have been stretched too far and have been “sprained.” This most commonly happens when your big toe is extended forcibly toward the top of your foot. This may happen abruptly from a fall or when something lands on the back of your calf while your toes are touching the ground. Turf toe commonly occurs from jamming your big toe into a hard surface. Occasionally, the injury happens over a long period of time from repetitive stress- like pushing off of the big toe each time you run or jump.
The term “turf toe” was coined because this injury became more common in athletes with the implementation of artificial turf fields. Turf toe injuries rank third after knee and ankle injuries among the most common cause for lost playing time in athletes.
A turf toe injury causes pain and swelling at the base of your big toe. You will notice your pain probably increases when your toe is straightened or bent backward toward the top of your foot. Sometimes you may notice bruising shortly after the injury. Gout, a type of arthritis that is more common in men, can sometimes act like turf toe. Be sure to tell your doctor if you or someone in your family has a history of gout.
Early treatment is focused on keeping your toe from moving too much. Depending upon the severity of the injury, turf toe usually requires a period of rest for proper healing. When directed, you may begin non-weight bearing activities, such as stationary cycling or swimming. You should take a close look at your shoes before returning to play. Wearing excessively flexible shoes on a turf field increases your chance of injury. Consider a stiff-soled shoe or hard carbon fiber insert during initial healing. When you are able to run and change directions without pain or loss of mobility, you will likely be allowed to return to play. Be sure to ice your toe for 10-15 minutes following any activity while your injury is healing.
My ankle hurts…….
The posterior tibialis muscle begins deep in your calf. The muscle is connected to the arch of your foot by a tendon that runs along the inside of your ankle, just behind the large bump called the medial malleolus. When you walk, the posterior tibialis muscle lifts the arch of your foot. 
Posterior tibial tendon dysfunction is one of the most common foot and ankle problems. The tendon may be damaged from an acute injury, like an accident or fall. More commonly, problems arise from overuse or repeated strain. Ongoing irritation slowly damages the tendon’s fibers and eventually leads to weakening and degeneration. This decreases the tendon’s ability to support your foot when you walk. As the tendon becomes less effective, the arch of your foot is allowed to collapse, which further increases the strain on the muscle and tendon.
The condition is often triggered from overuse and/or training on excessively hard surfaces. Other factors that can contribute to posterior tibial tendon dysfunction include: obesity, diabetes, hypertension, prior surgery or steroid injections.
Symptoms include pain or swelling along the course of the tendon, particularly behind your inner ankle bone. Symptoms often begin following an increase in training intensity or duration. Standing, walking, or running will likely increase your discomfort. Your pain may be aggravated by spending prolonged periods of time on your feet, especially, when standing tiptoe and walking stairs or uneven surfaces.
Early diagnosis and treatment is important to slow progression of the disorder. You may need to temporarily limit weight-bearing activity to allow your tendon to heal. Using a stationary cycle, elliptical machine, or swimming can be good alternatives to walking and running. Your doctor will likely prescribe arch supports or orthotics to help support your foot. You will be given exercises to strengthen the posterior tibialis muscle. These exercises should be performed while wearing shoes with good arch supports. In certain instances, a walking cast or boot may be needed to temporarily protect your foot.
What patients respond better to chiropractic manipulation versus physical therapy?
In discussions with physicians, we are often asked: “What patients respond better to chiropractic manipulation versus physical therapy?”. This is an excellent question as the emerging healthcare model demands that PCP’s select the most cost-efficient and clinically effective management for every case. Almost all musculoskeletal conditions have a defined “best practice” recipe and different conditions require a toolbox of different specialists.
Some neuromusculoskeletal conditions like a spinal cord injury or post-surgical rehab, are nearly always better managed by a therapist. Other conditions like uncomplicated ankle or knee sprains can typically be managed equivocally by either. But when dealing with mechanical LBP, neck pain, and cervicogenic headache, the research is clear – chiropractic spinal manipulation is the most effective option.
In fact, earlier this year the American College of Physicians published a clinical practice guideline (the ultimate synthesis of research) recommending that for acute or chronic LBP, physicians delay pharmacologic management and consider “spinal manipulation, heat, massage or acupuncture”- with no recommendation for therapy modalities. (1)
Furthermore, a new randomized clinical trial comparing outcomes for neck pain patients treated with manual joint mobilization vs. physical therapy demonstrated that the manual therapy group required significantly fewer treatment sessions (6.1 vs. 10.0 treatments at 52 weeks). (2)
Medical physicians, chiropractors, and physical therapists must work together to provide integrated “best practice” care. This means recognizing each other’s strengths and limitations while choosing the best possible option regardless of personal or professional bias.
Our providers understand who to treat and more importantly who not to treat. We strive to employ best practice management for every patient, every encounter. We are proud to co- manage our patients and will work hard to maintain your trust.
CTS Warning Signs
Headaches are REALLY common! In fact, two out of three children will have a headache by the time they are fifteen years old, and more than 90% of adults will experience a headache at some point in their life. It appears safe to say that almost ALL of us will have firsthand knowledge of what a headache is like sooner or later!
Certain types of headaches run in families (due to genetics), and headaches can occur during different stages of life. Some have a consistent pattern, while others do not. To make this even more complicated, it’s not uncommon to have more than one type of headache at the same time!
Headaches can vary in frequency and intensity, as some people can have several headaches in one day that come and go, while others have multiple headaches per month or maybe only one or two a year. Headaches may be continuous and last for days or weeks and may or may not fluctuate in intensity.
For some, lying down in a dark, quiet room is a must. For others, life can continue on like normal. Headaches are a major reason for missed work or school days as well as for doctor visits. The “cost” of headaches is enormous—running into the billions of dollars per year in the United States (US) in both direct costs and productivity losses. Indirect costs such as the potential future costs in children with headaches who miss school and the associated interference with their academic progress are much more difficult to calculate.
There are MANY types of headaches, which are classified into types. With each type, there is a different cause or group of causes. For example, migraine headaches, which affect about 12% of the US population (both children and adults), are vascular in nature—where the blood vessels dilate or enlarge and irritate nerve-sensitive tissues inside the head. This usually results in throbbing, pulsating pain often on one side of the head and can include nausea and/or vomiting. Some migraine sufferers have an “aura” such as a flashing or bright light that occurs within 10-15 minutes prior to the onset while other migraine sufferers do not have an aura.
The tension-type headache is the most common type and as the name implies, is triggered by stress or some type of tension. The intensity ranges between mild and severe, usually on both sides of the head and often begin during adolescence and peak around age 30, affecting women slightly more than men. These can be episodic (come and go, ten to fifteen times a month, lasting 30 min. to several days) or chronic (more than fifteen times a month over a three-month period).
There are many other types of headaches that may be primary or secondary—when caused by an underlying illness or condition. The GOOD news is chiropractic care is often extremely helpful in managing headaches of all varieties and should be included in the healthcare team when management requires a multidisciplinary treatment approach.
Aberdeen Chiropractic 