Several NFL players have been afflicted with ‘turf toe’ recently, most notably Ray Lewis of the Baltimore Ravens and Mark Ingram of the New Orleans Saints.  (Funny how so many players are getting hurt on PLAYOFF teams??)  I wanted to review with everyone exactly ‘what is turf toe’ and what players and trainers need to do to get back on the field quickly and safely.

First, turf toe, which will typically occur to the big toe joint (first metatarsophalangeal joint), occurs when the foot is plantarflexed (toes bent down) in a fixed position and has force placed upon it.  In a nutshell – when defensive players are crouching down at the line of scrimmage, the stance that they take to bounce off of their feet puts them at risk for turf toe.  It is a sprain of several of the TEN ligaments that make up the big toe joint.  Sometimes there can even be a little fracture of the sesamoid bones associated with it.  Depending on which ligaments are sprained and if there is a fracture (MRI and xray can show us that) will factor in on how long a player must be off the field.  Most of the time with aggressive physical therapy to strengthen the ligaments and a stiff soled shoe to not allow ‘bending’ of the toe at the big toe joint for 4-6 weeks will do the trick.  This is always accompanied by icing several times/day, anti-inflammatories, and even steroid shots if needed. 

In many cases, athletes will need functional, custom orthotics in their cleats to help prevent the injury from occurring again.  Rushing back from this type of sprain without the additional support of an orthotic can cause arthritis in the big toe joint – possibly leading to surgery.  Since the Chicago Bears don’t have to play either the Saints OR the Ravens this December, I am hopeful that both Ray Lewis and Mark Ingram recover nicely from their injuries! :)

As any Chicago Bears fan can attest, these past two weeks have been torture.   First, we are 7-3 with an edge over several other wild card playoff teams, THEN tragedy struck!  Jay Cutler, the quarterback we always knew he could be, was OUT with a broken thumb.  I get a lot of questions about what seems to us as fans as ‘little injuries’ for foot related problems (Baltimore Ravens Linebacker, Ray Lewis’ Turf toe will be a post NEXT week!).   But as I am not familiar with Cutler’s injury I decided to investigate…

Here’s the nitty-gritty of what’s going on and how LONG we have to deal with Caleb Hanie!

Jay has a “Bennett fracture” first described in 1882.  The reason it is a problem (especially for professional athletes!) is that it is intra-articular – it passes through the thumb and hand joint space (carpo-metatacarpal).  High incidence of arthritis for ANYONE, so it is important to treat it early and get good reduction of the injury – especially an NFL Quarterback on his throwing hand L

Jay had surgery on November 23^rd and reported that his orthopedic surgeon placed three screws and two pins to reduce and stabilize the fracture.  The pins can come out quickly IF the soft tissues heal around correctly, most importantly the abductor pollicis longus muscle attachment – the muscle that lets us grasp and pinch things like a football! 

According to Cutler, we may see him back in time for the Week 17 game versus Minnesota.  That would be cutting it close but HOPEFULLY the Bears can pull out 3 more wins (I am predicting that they will kill the Broncos, Seahawks, AND Vikings!!  Even with Forte out, I love my Bears!  And beating Green Bay would be AWESOME!) and get that wild card spot – déjà vu from last year with our beloved Bears will run that table and make it to Indianapolis in February!!!  (I have a great baby Bears cheerleader onsie from my friend Tricia that will be perfect for our Super Bowl Party!!)

Well, we are rolling right along heading into week 6 of the NFL and I have seen so many reports of players suffering from ‘high ankle sprains’.  Most recently, Sam Bradford of the St. Louis Rams, who will be OUT against the Packers this Sunday (I care because I need/want the Packers to lose so the Bears stand a fighting chance in the division!)

So what is a ‘high ankle sprain’?  It’s actually something completely different than the traditional “I rolled my ankle stepping off a curb” sprain.  It is a tear or separation of the interosseous (between bone) or syndesmotic ligament of the 2 leg bones (tibia and fibula).  Normally the fibula (the outside ankle bone) sits a little bit behind and to the side of the tibia.  It is held in place by three factors: 

1. Knee ligaments
2. Ankle ligaments
3. Interosseous ligament

If that IL is damaged, torn, or strained, it can cause instability in the ankle (not a good thing for anyone, let alone a professional athlete!) and perhaps further injury down the line (like weakening the ligaments around the ankle which could cause a more traditional ankle sprain).

Treatment consists of the PRICE therapy – Protect, Rest, Ice, Compress, and Elevate.  Most athletes are able to recover in 4-6 weeks if swelling allows them into regular shoe gear.  Four-six weeks is just enough time for Sam Bradford to NOT play against Aaron Rodgers.

My husband Scott and I are “co-owners” of a fantasy football team this year.  We picked our players together during the draft and had VERY high hopes with some of our returning picks (Packers Defense anyone??).  But our Achilles heel, pun intended, was our Quarterback pick, Ben Roethlisberger from the Pittsburgh Steelers.  Big Ben obviously had a great season last year and we were oh so confident that he was an AWESOME pick for our 2011 FF team.

I won’t talk about weeks 1-3.  They were enough to bench him.  But now, after the Steelers tough loss to the Houston Texans last week, our thoughts of sitting Big Ben are serious and definitely ‘foot related’.  (Our back up is Kyle Orton, you can see the dilemma here!)  The highlight’s from the game tell the full story – stepping onto his left foot and having an opposing team player bend and twist it in the wrong direction sent chills up my husband’s spine and me Googling what Roethlisberger’s MRI looked like to see if it was a lisfranc dislocation. 

Ben has played, and played WELL, with serious foot and ankle problems in the past.  The repetitive trauma to his feet will leave him with arthritis and residual pain, no doubt, but fortunately this injury DOES appear to be less serious and he already has experience with that protective boot.  The real question is, SHOULD he play?  When huge salaries and entire seasons (and a city’s love) are on the line, Ben has a huge decision to make.  Risk further, more painful injury on a week foot or appropriately rehab it once and for all.    

So do we bench him?  That is our $20 question (the entry fee into our FF league!).  We have already been pummeled by our opponents (yeah, we are the Miami Dolphins of the FF league) so far this year so what could it hurt to see if he can make some magic with that boot?  Besides Denver (and Orton) aren’t looking very good either as our backup options…

With the NFL preseason in full swing, I can’t help but notice as I watch SportsCenter that more and more players are being pulled for injuries.  One interesting statistic is the in the first 10 days of training camp in 2011, TEN PLAYERS ruptured their Achilles tendons!  Is this a result of poor conditioning in the offseason?  It may also be from a tendon that had previous injuries (i.e. playing professional football!) that was weakened for some reason.  Either way, it is a serious injury that MUST be treated immediately.

Typically, the athlete will feel a “popping” sensation when moving either forward or backward from a standing or crouching position.  The sudden force of speed can cause the Achilles to rupture.  The Achilles tendon is the strongest tendon in our body – but it has some weaknesses!  Most importantly, the Achilles does not have a typical ‘tendon sheath’ that protects it as it glides in the back of the leg and ankle.  The area approximately 2-6cm proximal (toward the knee) to the insertion at the back of the heel bone is especially weak because there is a limited blood supply to that area.  90% of ruptures occur here.

Treatment is surgery – in an athlete, this needs to be performed immediately to minimize swelling and further tissue damage.  After surgery, patient’s must remain non-weightbearing for a minimum of 8 weeks (sometimes sooner IF they are in protective walking casts or in early physical therapy) to allow the tendon to fully heal.  Physical therapy to regain strength and flexibility is also required and should be personalized to each patient and their needs.  In the professional athlete, this will mean significant amounts of therapy for weeks and even months after surgery.

The good news is – this is an injury that can be treated quickly and effectively.  Once rehabilitation is performed, most professional athletes are back on the field within 12 weeks.   So here is hoping that Illinois Alum Mikel LeShoure is back playing for the Detroit Lions as soon as possible (but only after the Lions have lost to the Chicago Bears – my favorite team and NFC North rival! – twice!)

If you have questions about your Achilles tendon, or any sports injury you can call 309-661-9975 or schedule an appointment. If you want to chat sports with Dr. Lockwood you can email her at DrLockwood@heartlandfootandankle.com.