Toe Injury Decides the Fate of Super Bowl LI???

Will a toe injury determine this year’s Super Bowl winner?  If the Atlanta Falcon’s explosive All-Pro receiver Julio Jones has a dominant performance the Falcon’s will likely be raising the Lombardi trophy –but if he is held in check by the New England Patriot’s #1 rated defense it will more than likely be the Patriots receiving the trophy from Commissioner Roger Goodell.

Jones’ ability to break free of the Patriot’s secondary may be dictated by how much pain he has in his left great toe.  Jones suffered a dreaded “turf toe” injury back during the Falcon’s week 10 game against Philadelphia. He then reinjured the toe in the Falcon’s divisional playoff game against the Seahawks. However, he was back on the field for the NFC conference championship game which the Falcon’s won handily over the Green Bay Packers. Will he have residual symptoms or reinjure the toe in the Super Bowl? How much will the toe limit him in Sunday’s game? The answers to those questions will play out during Super Bowl LI and may ultimately determine the winner.

Turf Toe: what is it all about?

So what is a turf toe?  And why is it such a potentially devastating injury for an NFL wide receiver? A turf toe injury is a tearing of some, or all, of the strong joint capsule at the base of the big toe. The most dramatic example of a turf toe injury is an actual dislocation of the big toe joint (1st metatarsal-phalangeal joint).  To dislocate this joint, even if it subsequently pops back into place (as it often does), requires that the strong fibrous tissue at the base of the joint (Plantar plate) be completely disrupted. More commonly, but also quite serious, is a partial injury to the plantar plate –the strong fibrous tissue being partially torn. The most common mechanism causing a turf toe injury is when the big toe is forced upwards after it is jammed into the ground. However, injury to the plantar ligaments may also occur from repetitive loading rather than one specific injury.

Problems with Turf Toe

There are at least three elements to this injury that create problems:

First, tearing the plantar plate (the strong tissue that stabilizes the base of the big toe joint) causes bleeding around and in the joint.  Blood flow to the great toe is increased for months afterwards as the toe tries to heal. This leads to swelling, aching, and general discomfort –especially if the injured player tries to use the toe.  Imagine running after you had dropped a large rock on your big toe –Ouch!

Second, the injury may have done more than just tear the lower part of the joint capsule. Other structures can be damaged including the joint cartilage that allows the joint to move smoothly (and painlessly) back and forth (cartilage is the shiny white stuff on the end of a chicken bone).  If enough cartilage is damaged in the great toe significant arthritis in this joint can develop.

Third, the torn plantar plate (ligament) may not completely heal.  This can cause the joint to be loose and subject to chronic pain and re-injury.

Treatment and Recovery

How is a turf toe treated? Initially, rest, ice, compression, and elevation (R.I.C.E) is used to help settle the acute pain –this can take anywhere form a few days to a few weeks to settle. Keeping the toe relatively immobilized to allow for healing of the injured structures is critical.  This may be done initially by putting the injured player in a rigid-soled walker boot, and then transition them to a stiff-soled shoe.  This usually serves to settle the symptoms over time in an average person who can back off their activities.

But, what about an elite NFL receiver like Julio Jones? His success on the field is dependent upon his ability to explode off the line of scrimmage, and leap high into the air to catch passes all the while he is being covered by ridiculously strong, fast, and large defensive players. He needs every advantage he can get to separate from these defenders. The force and motion going through his great toe joint as he does these maneuvers is staggering -often many, many times his body weight. This is not only extremely painful, but can (and often does) disrupt the healing process.

Doctors and trainers can help manage these symptoms with shoe modifications (stiffening the soles) and perhaps various types of injections.  However, shoes that are too stiff and restrictive may limit the performance of player’s like Jones. For some players this balancing act is negotiated successful and the player can play at near 100%.  For others, the limitations can be profound causing them to miss games and perhaps require surgery to clean out the great toe joint and repair the damaged joint capsule. It remains to be seen to what extent Julio Jones is affected by his toe injury. Hopefully he is at 100% and Super Bowl LI is a great game.  Enjoy it!

Stephen Pinney MD

5 Risk Factors for Ankle Sprains

An ankle sprain or "rolling your ankle" is one of the most common musculoskeletal injuries. However, not every person has an equal risk of spraining her ankle. Are you more likely than the next person to suffer an ankle sprain? Here are five risk factors:

1. A history of ankle sprains
If you have sprained your ankle many times in the past you are likely to sprain it again in the future. Often these individuals will have a combination of the other risk factors. They may have developed chronic ankle instability due to stretching out of the injured ligaments.

2. Participation in high-risk sports
Certain sports predispose to ankle sprains more than others. Basketball and volleyball players who often land awkwardly on someone's foot after jumping have an increased risk of injury. Similarly, soccer and tennis players who regularly have to change directions quickly also commonly suffer ankle sprains.

3. Loose joints
Are you “loose-jointed”? In medicine, this is called “ligamentous laxity.” Can you hyperextend your elbows? Can you touch your thumb to your forearm? Can you bend a finger so that it makes a 90° angle with the back of your hand? If you can, you have looser ligaments and are at a higher risk of spraining your ankle.

4. A high arched foot
People with higher arched feet can usually roll their foot inwards more than they can outwards. This makes it more likely that they will sprain their ankle.

5. Weak muscles
When your ankle rolls inwards, often the last thing that prevents it from going further and tearing the ligaments is a strong contraction from the muscles on the side of the leg that supports the ankle. If these muscles are weak or do not react in time, an ankle sprain will occur. Most people with weak muscles do not realize it; because the only time they need this strength is when the ankle is in a “high-risk” position for spraining. Keeping these muscles strong can help minimize the risk of an ankle sprain.

To learn more about ankle sprains or treatments for ankle instability check out

Stephen Pinney, MD


5 things you probably didn't know about bunions


The term "bunion" is derived from the Latin word for turnip. The medical term for bunions is Hallux (big toe) Valgus (pointing away from the midline).
Tight shoes do NOT cause bunions. Rather, you can usually blame your parents. More than 80% of patient with bunions have a first-degree family member with a bunion. However, if you have a bunion and wear constrictive shoes it will cause pain –so comfortable shoes are still very important!
There's very little correlation between the size of a bunion and how painful it is. It is natural to think that a big bunion = lots of pain, and a small bunion = very little pain.  However, that is not the case. Small bunions can be very painful, and many large bunions cause no symptoms at all.
 The vast majority of bunions can be treated effectively without surgery. Only a small percentage of patients with bunions will need surgery. Most bunions can be managed effectively without surgery. Simple non-surgical treatments like wearing a shoe with more width and a softer upper can be very effective at decreasing or eliminating bunion symptoms.
Bunion surgery is not a cosmetic procedure. Bunions that are not painful should not be operated on. The recovery from surgery is considerable and “there is no operation that has ever been invented that can’t conceivably have a complication.” These are two of the reasons why performing cosmetic bunion surgery (surgery in the absence of significant symptoms of discomfort) has been identified by the “Choose Wisely” campaign as an unnecessary procedure.

For more information on bunions check out the FootEducation bunion page!
Stephen Pinney MD

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