My Big Toe Joint Hurts!

A sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint.
Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe pushes off during walking or running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.

Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. They are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequent wearing of high-heeled shoes can also be a contributing factor.
There are three types of sesamoid injuries in the foot:

• Turf toe. This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain, and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Turf toe may result in an injury to the soft tissue attach to the sesamoid or a fracture of the sesamoid. Sometimes a pop is felt at the moment of injury. 
• Fracture. A fracture in a sesamoid bone can be either acute or chronic. An acute fracture is caused by trauma- a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint. A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, is generally aggravated with activity and relieved with rest.
• Sesamoiditis. This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure to the sesamoids. Often, sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.

In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient's walking and evaluate the wear pattern on the patient's shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.
Non-surgical treatment for sesamoid injuries of the foot may include one or more of the following options, depending on the type of injury and degree of severity:

• Padding, strapping, or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension. 
• Immobilization. The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the pain and inflammation.
• Physical therapy. The rehabilitation period following immobilization sometimes includes physical therapy, such as exercises (range-of-motion, strengthening, and conditioning), and ultrasound therapy. 
• Steroid injections. In some cases, cortisone is injected in the joint to reduce pain and inflammation. 
• Orthotic devices. Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot.

When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. The podiatrist will determine the type of procedure that is best suited to the individual patient.
If you are an athlete suffering from a sesamoid injury or any other sports injury, call our Newington, Kensington, or Middletown office to make an appointment.
Craig M. Kaufman, DPM
Connecticut Foot Care Centers
Sports Podiatrist in CT
Podiatrist in Newington, Kensington, and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.

Cardinals' Beanie Wells Has Turf Toe Injury

English: Beanie Wells and Cardinals runningbacks (Photo credit: Wikipedia)

The Arizona Cardinals have been on a winning streak, but luck often runs out- and it may have during Sunday's game.
Darren Urban of AZCardinals.com tweeted "Beanie Wells said he could have turf toe. He and Darnell Dockett will be checked out tomorrow." Starting running back Beanie Wells has a dreaded turf toe injury, an injury he sustained in the third quarter against the Philadelphia Eagles. As we've blogged about recently, a turf toe injury can mean a long recovery.
Wells, who has been relatively ineffective these first few games of the 2012 season, who had been listed as probable with a knee issue entering the Week 3 game at home. By the time Wells had left the game on Sunday, he had rushed just 18 yards on eight carries. Cardinals fans have been disappointed with the former first round pick this season. Overall, he has run just 76 yards on 29 carries and hasn't scored a touchdown yet.
Head coach Ken Whisenhunt has been taking the committee approach in the running game, but that hasn't worked thus far this season.
Substitute Ryan Williams came into the game and averaged 6.4 yards per carry, with 83 yards on 13 carries.
If you are are suffering from a turf toe injury, call our Newington, Kensington, or Middletown office to make an appointment.
Craig M. Kaufman, DPM
Connecticut Foot Care Centers
Sports Podiatrist in CT
Podiatrist in Newington, Kensington, and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.

Related articles

• Turf Toe Injury

Turf Toe Injury

Turf toe is a sprain of the big toe joint resulting from injury during sports activities. The injury usually results from excessive upward bending of the big toe joint. The condition can be caused from either jamming the toe, or repetitive injury when pushing off repeatedly when jumping or running. Although this injury is most commonly reported in football players, participants in soccer, basketball, wrestling, gymnastics, and dance are also at risk.

The name turf toe comes from the fact that this injury is especially common among athletes who play on artificial turf. When playing sports on artificial turf, the foot can stick to the hard surface, resulting in jamming of the big toe joint. There has also been some indication that less-supportive flexible shoes worn on artificial turf are also to blame.
The signs and symptoms of turf toe can include pain, swelling, and limited joint movement.
If turf toe is caused by repetitive actions that cause injury, the signs and symptoms will usually begin slowly and gradually worsen. Turf toe can also be caused by a direct injury leading to damage of the bone beneath the cartilage. If direct injury is the cause, the signs and symptoms may begin suddenly and get worse over a 24 hour period.
To arrive at a diagnosis, the podiatrist will obtain your medical history and examine your foot. X-rays are typically ordered to rule out any broken bone. Other advanced imaging studies may also be helpful for proper diagnosis.
Initial treatments include R.I.C.E., as well as a change to less-flexible footwear. Operative treatment is reserved for individuals with severe cases and prolonged pain.
If you are an athlete suffering from turf toe or any other sports injury, call our Newington, Kensington, or Middletown office to make an appointment.
Craig M. Kaufman, DPM
Connecticut Foot Care Centers
Sports Podiatrist in CT
Podiatrist in Newington, Kensington, and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.

Foot Injuries in Soccer

Toenail Bruise: This injury usually occurs when another player steps on your foot, most commonly the big toe, resulting in mild to moderate pain and later a black toenail. The black/purplish discoloration is caused by traumatic injury to the blood vessels beneath the toenail. The pain generally will intensify in the acute phase (0-24 hours) due to the increase of pressure caused by leaking blood. If the discomfort is significant see a podiatrist who can help by drilling a small hole in the nail with a needle which allows the blood to leak out, relieving the pressure. This is best done within the first 24 hours of injury. Despite how it may sound, the procedure is painless. Your doctor can also check to make sure there aren't any other associated injuries like a broken bone or joint sprain. It is hard to predict whether or not the nail will fall off. Chances are highest if it has already become loose. You can tape the nail to try to hold it in place, but if it falls off you will probably want to protect the exposed sensitive tissue with padding when playing until a new nail grows in.

Ingrown Toenail: This occurs when a toenail grows downward into the toe pad rather than straight outward. The surrounding soft tissue becomes inflamed, red, swollen, and painful to touch or even when walking. On some occasions, the surrounding soft tissue can become infected with bacteria causing a discharge that is usually white or yellowish in color. It is seen with regular training and constant downward force generated by running and quick sprinting. Almost exclusively, the big toes are affected. Prevention can be accomplished with proper nail trimming technique. Trim toenails in a directly horizontal fashion leaving a small corner of nail extending just beyond the toe pad on either side. Should an ingrown toenail develop, there are a couple of ways it can be treated. If it is early and not infected, soak in warm Epsom salt water for 15-20 minutes 2-3 times daily. Shimming under the affected nail edge with cotton can help. Do not cut the nail corners as this only encourages the nail edge to grow further down and in. Should these measures fail or the surrounding soft tissue becomes infected see a podiatrist who may decide to prescribe antibiotics or remove part of the nail with a simple in-office procedure. This allows the soft tissue to heal and new nail to then grow in correctly over the next several months.

Turf Toe: This is a sprain of the first metatarsophalangeal joint (where the big toe meets the foot) occurring when the big toe is used like a springboard to propel the foot forward during sudden changes in running direction. It tends to be more common in those with flat feet, play on artificial turf (hence the name), or those participating in soft/flexible sole cleats. Indoor players may be particularly at risk. Symptoms usually include swelling and pain around the first MTP joint of the foot that gets worse with walking or movement of the affected toe. As with any injury it is always a good idea to see a doctor to confirm the diagnosis. Treatment consists of regular 15-20 minute icing sessions, anti-inflammatory pain medications, and decreased weight bearing activity for a few days to weeks. As you try to return to play, an athletic trainer may tape the joint or a rigid insert can be placed in the front of your shoe to limit extension of the big toe joint as you push off the ball of your foot. Outside of soccer, wear supportive, stiff-soled shoes to limit strain on the toe with regular walking. Recovery may take several weeks.

Toenail Fungus: This condition is caused by fungal organisms known as dermotophytes which are typically transmitted via contact with a colonized surface (shower floor, flip-flops, shoes, socks, etc). This is an infection of the nail itself, typically causing thickened, discolored (whitish-yellow), and brittle nails. Spreading to other nails on the same foot is a common problem. Toenail fungus is primarily a cosmetic problem and will generally not cause any other problems. Treatment of topical medications directly to the nail have had good success rates in our offices. Other options include laser treatment and oral medications.

Athlete's Foot: This is a burning/itching red rash on the feet located mostly between the toes but may spread onto the foot. It is caused by the same group of organisms that cause toenail fungus. These organisms flourish in warm, wet, dark places- which makes the feet/toes a perfect set-up- and can easily be passed between teammates. Again, shower floors, sharing shoes, locker room floors, etc. are the most likely sources. To prevent this problem: 1. Avoid barefoot exposure in locker rooms, gyms, showers, or sharing shoes, 2. You may also consider using baby powder on your feet with each practice/game to prevent excess moisture build-up, 3. Change your socks frequently and remove shoes as soon as possible after play (it helps to have a pair of sandals ready). Should you develop symptoms of Athlete's foot, you should visit a podiatrist to discuss treatment options.
If you are a soccer player with a foot injury, call our Newington, Kensington, or Middletown office to make an appointment.
Craig M. Kaufman, DPM
Connecticut Foot Care Centers
Sports Podiatrist in CT
Podiatrist in Newington, Kensington, and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.