Toe Jams March Madness Bracketology

Even runners are watching March Madness right now. College basketball will have the nation riveted to their TV and discussing this year's Cinderella stories. The biggest health story of the tournament so far is the jammed big toe of North Carolina's Ty Lawson.

Wayne Ellington had 25 points for the Tar Heels (29-4), who led the entire way and had no trouble beating the 16th-seeded Highlanders in their opening game of the tourney, even with point guard Ty Lawson, who missed his third straight game with this toe injury.

Ellington’s day more than offset the loss of Lawson, who has been slow to recover from a jammed right big toe suffered in practice two days before the regular-season finale against Duke. Lawson played 36 minutes in that game, but the toe swelled unexpectedly the day after and forced him to miss both of the Tar Heels' ACC tournament games.

Lawson has said he is feeling better and battling more stiffness than pain, adding he thinks he'll play Saturday. Is this too soon? Will he be able to play up to his normal potential?

And more important to most readers at home, what does this do to the bracketology? Even President Obama has picked the Tarheels to win the national championships, but if Lawson is not 100%, can they win?? Many athletes who have suffered a jammed big toe (a.k.a. turf toe) will tell you it takes months to get over that kind of injury. Many a season has been tarnished by turf toe. The latest was the San Diego Charger’s LaDainian Tomlinson whose entire season was a disaster due to turf toe. Ask him, he will tell you what a pain in the toe!

What is turf toe?

Turf toe is a condition of pain in the base of the big toe. This usually caused from either traumatically jamming the toe, or pushing off repeatedly when running or jumping. The most common complaints are pain, stiffness and swelling. The pain can be so severe that pushing off in football is virtually impossible.This injury is especially common among athletes who play on artificial turf, hence the name “turf toe”. The hard surface combined with running, jumping and cutting in football and soccer, make turf toe a frequent injury. Some also blame the choice of athletic footwear. The more flexible shoes, especially used in competition, provide less support to the forefoot joints, possibly contributing to the incidence of turf toe.

How does turf toe occur?

When a player sustains a turf toe injury they are actually tearing the capsule that surrounds the joint at the base of the big toe. Tearing this joint capsule can be extremely painful. Furthermore, tear of the joint capsule can lead to significant instability and even dislocation of the joint at the base of the toe. This may lead to accelerated cartilage wear and arthritis of the big toe known as Hallux limitis or rigidus. This wear-and-tear arthritis can end a promising career prematurely.

How is turf toe diagnosed?

Turf toe is diagnosed based primarily on the physical examination of the patient. X-rays may be taken to ensure there is no fracture or evidence of arthritis. Occasionally an MRI is needed to evaluate the surrounding tendons or to rule out an occult stress fracture.

What is the treatment of turf toe?

Treatment of turf toe consists of trying to control the inflammation of the joint capsule. Treatment protocol can include:
1. Rest
2. Ice
3. Elevation
4. Taping or padding to off-weight the toe joint
5. Anti-inflammatories
6. And in chronic cases steroid injections to the joint may be helpful
7. Long term use of a functional foot orthotic to balance the forefoot in the athletic shoe is quite helpful.

Athletes diagnosed with turf toe should avoid stress to the joint for about three weeks to allow the joint capsule to heal. Once returning to activities, functional orthotics can be used to limit the motion of the big toe and prevent further damage to the joint capsule.

Will turf toe return?

Unfortunately, turf toe can return, often more severe than the initial injury, and rehabilitation may be very slow. Most athletes have trouble when they try to come back to sports too soon after sustaining a turf toe injury. Surgery is rarely needed for treatment of turf toe unless this has been a chronic injury and spurs are present in the joint limiting motion. If a bone spur has formed, and severely limits the motion of the toe joint, surgery to remove the spur may be helpful.

Prevention and early treatment is really the key! Unfortunately for the North Carolina men’s basketball team, recovery may be too late for a national championship; but you never know…..they call it Mrach Madness for a reason...anything can happen!