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CONDITION/DISORDER SYNONYM
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PREFERRED PRACTICE PATTERN3
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4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation
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PATIENT PRESENTATION
A 20-year-old football player hyperextended the great toe while playing on synthetic turf grass. He thinks his cleat may have gotten stuck in the turf while being tackled. The patient has a painful and swollen MTP joint of the great toe. He cannot walk or run without pain. Patient states the toe hurts the most when he tries to push-off with the toe/foot. The patient has a turf toe orthotic in his shoe.
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Sprain to the ligaments and capsule around the big (great) toe metatarsophalangeal joint (MTP or MTPJ)
Caused by a hyperextension or hyperflexion injury of the big toe, first MTP joint
Typically a sudden injury, common to fall (tackled) over a fixed foot overstretching the toe into hyperextension
Limited joint mobility at the MTP joint
Can involve the sesamoid bones (two small bones embedded in the flexor hallucis brevis)
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Essentials of Diagnosis
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Diagnosis is usually made by clinical examination or x-ray
Can be an independent diagnosis and not associated with a disease process
Three grades of severity classification5
Grade 1 sprain: Minor stretch injury to the soft-tissue restraints with little pain, swelling, or disability
Grade 2 sprain: Partial tear of the capsuloligamentous structures with moderate pain, swelling, ecchymosis, and disability
Grade 3: Complete tear of the plantar plate with severe swelling, pain, ecchymosis, and an inability to bear weight normally
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General Considerations
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Pain and swelling
Inflammation around the first MTP joint
Will alter mechanics during the push-off phase of gait
If not managed properly, arthritis, spurring, and osteophytes can develop
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Commonly seen in athletes playing on artificial surfaces
Can happen on grass with a shoe that does not adequately support the foot (such as soccer shoes)
Dancers, football players, rugby players
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