SLIDE 1
Turf toe
- how to prevent this injury,
Conflicts
- None for this talk
- Consultant with Arthrex, Stryker, Integra
- Royalties from Arthrex, Stryker, Integra,
Erchonia
- Textbook royalties- Elsevier
Turf toe -how to prevent this injury, conservative treatment - - PowerPoint PPT Presentation
Turf toe -how to prevent this injury, conservative treatment - - PowerPoint PPT Presentation
Turf toe -how to prevent this injury, conservative treatment Michael J Coughlin, M.D. Conflicts None for this talk Consultant with Arthrex, Stryker, Integra Royalties from Arthrex, Stryker, Integra, Erchonia Textbook royalties-
SLIDE 2
SLIDE 3
NFL study of turf toe
- Bob Anderson / Mike Coughin
- Rich Kent , Jeff Crandall (Univ Virginia)
- Studied injury films
- Anatomic testing of Turf toe model
- Assessment of NFL players
- Computer modeling
SLIDE 4
NFL
- Injury and survelliance
- Kept statistics for > 30 years
- Data entered by trainers
- Incidence of Turf toe injuries
- ver last 20 years
SLIDE 5
CENTER for APPLIED BIOMECHANICS-UVa
Tear Medial phalangeosesamoid ligament distal to medial sesamoid
Primal Pictures, 2009
Pl Do Pr Di
Cadaveric simulation-NFL study
SLIDE 6
Fundamental Research Driving Product Design through Assessment
Low er limb
Interpret Equipment Behaviors
Turf toe Toe flexion angle performance Injury risk
SLIDE 7
Risk Factors
- Increasing age
- Increasing weight
- Longevity of play
- Pes planus
- Decreased MTP ROM
SLIDE 8
NFL injury and safety committee What we perceived as causes
- Lightweight flexible shoes used
- n turf
- Increased flexion of forefoot
SLIDE 9
- Players want lighter,
“faster shoes
- Have little regard for
possible injury
- It wont happen to them
SLIDE 10
Biomechanics
- Normal active 80° active & 105°
passive ?????
- 60° extension with barefoot motion
- 40° extension in shoes
- Sliding is replaced by compression at
limits of extension
- Extreme extension can result in
impaction of phalanx on metatarsal!!!
SLIDE 11
Classification
- Grade 1
- Grade 2
- Grade 3
- Grade 4
- Stretch, sprain
- Partial tear
- Disruption of
cap-lig complex
- Articular crush
injury
Coughlin MJ: Turf toe injuries to the Hallux MTP Joint. 2003.
SLIDE 12
Athletic Participation
- Grade 4-”the ball game is over”
SLIDE 13
McDuffe film
SLIDE 14
Imaging
Dorsiflexion stress views
SLIDE 15
Radiographic findings
- Retracted sesamoids-
SLIDE 16
Imaging
- Bone Scan
– Differentiate bipartite and fracture
SLIDE 17
Ultrasound
SLIDE 18
Imaging
- MRI
–Definitive study of capsular disruption, plantar plate disruption, and articular damage –Sagittal images for capsular pathology
SLIDE 19
- T2 sagittal STIR sequence of the
great toe. Arrow demonstrates rupture of the capsular ligamentous complex just distal to the medial sesamoid bone.
McCormick and Anderson (2009)
SLIDE 20
5 year project
- Goal-to diminish incidence of turf toe
injuries in the NFL
- One million dollar project
- Headed-Bob Anderson,M. Coughlin
- Hired engineers from Univ of Virginia
– Jeff Kent, Rich Crandall
SLIDE 21
Turf Toe Testing-Univ. Virginia
SLIDE 22
44° 40°
What normally happens!!!
SLIDE 23
Vulnerable Foot Position (Turf Toe)
SLIDE 24
56° extension 99% of athletes low risk of injury
Move the curve to the left
SLIDE 25
Stiffen the shoe
We test all shoes now, and reject those that are too flexible
SLIDE 26
Prevention
- We have installed regulations for
turf in all stadiums
- Probably less the turf that the shoe
- OUR GOAL
- Change in the shoe model
- “a safer shoe”
SLIDE 27
Shoe inserts
SLIDE 28
Drawer test pre-op
SLIDE 29
Drawer after
SLIDE 30
Have we succeeded?
- 2008-more frequent injuries
- 2016-17- markedly decreased
- Players still choose their shoes-
- but we are making a