Pain In Great Toe Research Articles

Ayurvedic management of Vatarakta with special reference to Gout: A Case Study

Vatarakta is a disease explained in Ayurveda involving Vata Dosha imbalance affecting Rakta Dhatu, where the Vayu gets aggravated due to long distance rides on animals like elephants, camels, horses, and on the other hand Rakta or blood gets vitiated by the consumption of Lavana, Amla, Katu, Kshara etc. The Vata, whose passages are blocked by Rakta further undergoes vitiation and further contaminates the Rakta or blood. The blood vitiated by Vayu later burns the whole blood in the body and later gravitates towards thefoot. This vicious amalgamation of vitiated Vata and Rakta is called Vatarakta. Vatarakta can even be correlated to Gout on the basis of etiopathology. A 45 years old female patient approached the OPD with the chief complaints of: Right great toe pain, swelling along with discoloration. Right ankle joint pain, swelling along with burning sensation of b/l sole. Right wrist joint pain along with difficulty in movements & Generalised weakness was also seen. All the above complains were since 4 months. The patient was given completely Ayurvedic medicines such as Kaishor guggul, Amrutadi guggul, Sanshamani Vati, Guduchi kwath for oral consumption & Pinda Tail (Sukhoshna) for local application & sarvanganadisweda with dashmool kwath for 2 months, follow up was taken on every week for 2 months. The results were remarkably seen. Hence this study was taken to prove that Ayurvedic management has remarkable results in Vatarakta (Gout).

The Utility of Ultrasound in the Evaluation of Traumatic Hallux Valgus.

Level V.

Toe Pain - Softball

HISTORY: An 18-year-old collegiate softball player started noticing right great toe pain in March of her freshmen season. Pain was unrelenting throughout the day but temporarily responded to anti-inflammatories. She denied fevers, chills, night sweats, or unexpected weight loss. She did not report her pain to the team physician. However, after seeing an outside physician for continued pain, she was placed in a walking boot and provided a bone stimulator. After an additional three weeks of pain despite these therapies, she presented to the training room for re-evaluation of her toe. PHYSICAL EXAMINATION: Examination revealed exquisite tenderness to palpation of the dorsal-fibular aspect of the proximal portion of the distal phalanx of the right first toe, with mild swelling but no plantar tenderness. There was full passive and active range of motion of the MTP and IP joints. Skin of the right foot was intact, without erythema or induration. Tendon function was intact. The foot was neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1. Stress Reaction of right first toe distal phalanx 2. Subacute/Chronic Osteomyelitis 3. Bony Tumor TEST AND RESULTS: Right toe AP, lateral, and oblique radiographs- bony alignment is unremarkable, no acute fracture; joint spaces well preserved. MRI of right foot without contrast - diffuse marrow edema throughout the first distal phalanx; no corresponding focal signal hyperintensity in the distal phalanx.Nuclear medicine bone marrow imaging - mild increased radiotracer uptake in the region of the distal first phalanx suggesting increased regional blood flow. The above studies were reviewed by the team physicians and there was a concern for bony mass of the proximal portion of the dorsal fibular distal phalanx. MRI with contrast confirmed this suspicion. CT right foot without contrast with 3D reconstruction - ill-defined sclerosis in the medial aspect of the base of the first distal phalanx measuring 7 mm x 4 mm x 5 mm with faint lucency proximal to the sclerosis. FINAL WORKING DIAGNOSIS:Osteoid Osteoma TREATMENT AND OUTCOMES: 1. Continued anti-inflammatories with COX2 inhibitors for symptomatic treatment. 2. Surgical curettage and excisional biopsy of the 7 mm x 4 mm x 5 mm nidus; deferment of radiofrequency ablation due to proximity to the joint. 3. Anticipated return to play in 4-6 weeks.

Hallux valgus severity, great toe pain, and plantar pressures during gait: A cross-sectional study of community-dwelling adults.

Hallux valgus (HV) is a common disabling condition affecting 36% of adults aged 65 years and over. Identifying whether the severity of the deformity alters weight-bearing patterns during walking may assist clinicians optimize offloading interventions. Therefore, we examined how plantar pressure distributions during walking are affected by HV severity. Plantar pressures and maximum forces in ten regions of the foot were obtained from 120 participants (40 men, 80 women) aged ≥50 years using a pressure platform (RSscan® International, Olen, Belgium). HV severity was documented using a validated line-drawing instrument with participants separated into four groups: none (n = 30), mild (n = 30), moderate (n = 30) and severe (n = 30). Pressure and force values were compared across HV severity, stratified by the presence or absence of great toe pain. Participants with severe HV were more likely to have great toe pain. More severe HV was associated with significant reductions in peak pressure and maximum force under the hallux but not at other sites of the foot. This association appeared strongest in those reporting great toe pain. Greater HV severity is associated with great toe pain and reduced loading under the hallux when walking. These observed changes in plantar pressure and maximum force may reflect a pain avoidance mechanism.

Implementation and Validation of Anatomic Triplane Hallux Abducto Valgus Classification

Category: Bunion Introduction/Purpose: The most common classification system for HAV deformity is based on two-dimensional radiographs. This system relies upon measurements taken of the transverse plane. (IMA and HVA) to classify and deploy surgical options based on the severity of these angles [1]. Recently, the understanding of HAV deformity as a three-dimensional problem has been described. A study by Kim et al. [2] utilized WB-CT to describe a frontal plane rotational component in 87% HAV cases. To develop a better understanding of HAV, a unique anatomic classification system (see figure) was proposed. The aims of this study were: (1) To use traditional WB radiographs to confirm the findings of Kim’s WB-CT study. (2)To use inter-observer and intra-observer analysis to validate the classification of HAV into this new system. Methods: An Institutional Review Board approved multi-center retrospective study was performed utilizing four view WB radiographs (Anterior-Posterior, Oblique, Lateral and Axial Sesamoid) on patients presenting to the clinic for “bunion,” Hallux Valgus, HAV, Hallux Rigidus or “great toe pain.” The data were analyzed for the presence of frontal/coronal plane rotation of the first metatarsal, subluxation of the sesamoids, metatarsus adductus and degenerative joint disease of the first MTP (metatarsophalangeal) joint (Hallux Rigidus); these findings were compared to Kim’s study. Additionally, these data were used to categorize HAV deformities into a new 3D classification scheme and were tested for inter-observer and intra-observer reliability. Results: The results established the presence of frontal/coronal plane rotation and subluxation in similar ratios as reported by Kim et al. thus confirming the utility of a four-view WB radiograph series in recognition of 3D deformity of HAV. The results also confirmed good reliability of the classification from both the inter-observer and intra-observer standpoint. Conclusion: These data suggest that new protocols and tools are reliable in helping the surgeon recognize and better identify the three-dimensional components of HAV.

Turf Toe: 40 Years Later and Still a Problem

“Turf toe,” originally described in literature by Bowers and Martin in 1976, is an injury to the capsuloligamentous complex of the first metatarsophalangeal joint. This injury is common in football players. Up to 45% of National Football League (NFL) players have suffered from turf toe during their professional career. Turf toe injuries have been attributed to playing on hard, artificial surfaces with soft, flexible cleats; 83% of the turf toe injuries occurred on artificial turf. For most turf toe injuries, nonoperative treatment is the preferred approach, even in some cases with associated fracture of the sesamoids. Operative intervention should be considered after nonoperative management has failed or in cases of clear instability or sesamoid retraction. Good functional outcomes with high rates of return to play can be expected with appropriate management. Despite this, persistent symptoms of stiffness and great toe pain are not uncommon following initial injury, surgery or both. Due to limited availability of high-level evidence regarding the outcomes of turf toe injuries, particularly for surgical management of high-level athletes, this article will combine what is available with level V evidence based on the senior author’s experience over 34 years and his discussions with other experts in the unique subspecialty of foot and ankle sports medicine.

Manipulative and Multimodal Therapies in the Treatment of Osteoarthritis of the Great Toe: A Case Series

ObjectiveThe objective of this case series is to describe manual manipulative therapy with exercise for 3 patients with mild to moderate osteoarthritis of the great toe. Clinical FeaturesThree patients, a 32-year-old man, a 55-year-old woman, and a 49-year-old woman, had great toe pain of 8, 1, and 2 years, respectively. Each had a palpable exostosis, a benign outgrowth of bone projecting outward from the bone surface, and decreased dorsiflexion with a hard end-feel. Intervention and OutcomeManual manipulative therapy with exercise, the Brantingham protocol, was used with patients receiving 6, 9, and 12 treatments over 6 weeks. Specific outcome measures for hallux rigidus and the foot were chosen to document the effects of this intervention including digital inclinometry, the lower extremity functional scale, the foot functional index, overall therapy effectiveness and Visual Analogue Scale (VAS). Each patient had an increase in range of motion that surpassed the minimal clinically important change, an increase in the overall therapy effectiveness and a decrease in the foot functional index that surpassed the minimally clinically important difference. Most importantly for the patients, each reported a decrease in both usual and worst pain on the VAS that exceeded the minimally clinically important difference of 20 to 30 mm. ConclusionThe 3 patients reported decreased pain measured by the VAS, increased range of motion and minimally clinically important difference in 3 other outcome measures.

Increasing great toe pain in a patient with soft tissue swelling and nail enlargement

Increasing great toe pain in a patient with soft tissue swelling and nail enlargement

Musculoskeletal: What is different in children? Kicked another kid: pain in great toe

Musculoskeletal: What is different in children? Kicked another kid: pain in great toe

Quick Consult: Symptoms: Great Toe Pain and Swelling

Quick Consult: Symptoms: Great Toe Pain and Swelling

Great Toe Stuck in Dorsiflexion in a Marathon Runner

HISTORY: A 31 year old female marathon runner presented to our sports medicine clinic with a two-and-a-half month history of right great toe pain that started and gradually worsened during a fourteen mile run. Toward the end of the run, she took one step where her right great toe "became stuck up". She continued and finished the run. On arriving home, she "pulled" on her big toe and was able to bring it "down". Leading up to her visit, the patient continued to run daily, and taped her great toe in order to keep it aligned with the rest of her toes. She denies any history of direct trauma, warmth, swelling, prior injury or surgery. PHYSICAL EXAMINATION: Mild tenderness to palpation of the first metatarsophalangeal (MTP) joint on the plantar surface without any effusion, warmth, or erythema. Passive range of motion of the great toe - plantar flexion 20 degrees, dorsiflexion 90 degrees. Active range of motion of the great toe - plantar flexion 0 degrees, dorsiflexion 70 degrees. Positive valgus stress test to 1st MTP. Extensor hallucis longus strength 4/5, plantar flexion strength of great toe 3+/5. Sensation intact. Midfoot and ankle exam normal. DIFFERENTIAL DIAGNOSIS: 1) Turf toe 2) Sesamoiditis or sesamoid stress fracture 3) Flexor hallicus longus tear/tendonitis 4) Posterior impingement 5) Symptomatic os trigonium TEST AND RESULTS: Initial AP/lateral/oblique radiographs of her right foot revealed no abnormality. An MRI of her right foot without contrast revealed a linear area of edema in the peripheral aspect of the flexor hallicus longus tendon immediately adjacent to it, suggestive of tendinopathy/partial tear. An effusion is present in the 1st MTP joint without any bony edema around it. There is also subcutaneous edema in the plantar aspect of the 1st MTP joint and erosive changes around the head of the 1st metatarsal. FINAL WORKING DIAGNOSIS: Flexor hallicus longus partial tear TREATMENT AND OUTCOMES: 1) Restriction of weight bearing activity 2) Immobilization of foot/ankle with walking boot - two three-week courses 3) Transition into stiff sole shoe 4) Home exercise program with less weight bearing exercises such as swimming and biking

Manual and manipulative therapy compared to night splint for symptomatic hallux abducto valgus: An exploratory randomised clinical trial

Context Hallux abducto valgus (HAV) is a frequent cause of great toe pain and disability, yet common treatments are only supported by mixed or equivocal research findings. Surgery often only provides modest improvement and post-surgery complications may significantly hamper outcomes, implying the need for trials testing conservative treatment, such as manual and manipulative therapy, particularly in cases where surgery may be contraindicated or premature. The purpose of this exploratory trial was to test an innovative protocol of manual and manipulative therapy (MMT) and compare it to standard care of a night splint(s) for symptomatic mild to moderate HAV, with a view gather insight into the effectiveness of MMT and inform the design of a definitive trial. Design Parallel-group randomised trial set in an out-patient teaching clinic. Participants A convenience sample of 75 patients was assessed for eligibility, with 30 participants (15 per group) being consented and randomly allocated to either the control group (standard care with a night splint) or the experimental group (MMT). Intervention Participants in the control group used a night splint(s) and those in the experimental group (MMT) received a structured protocol of MMT, with the participants in the experimental group receiving 4 treatments over a 2-week period. Outcome measures Visual analogue scale (HAV-related pain), foot function index (HAV-related disability) and hallux dorsiflexion (goniometry). Results There were no participant dropouts and no data was missing. There were no statistical ( p < 0.05) or clinically meaningful differences (MCID < 20%) between the two groups based on outcome measure scores. However, the outcome measure scores in the control group (night splint) regressed between the 1-week follow-up and 1-month follow-up, while the scores in the experimental group (MMT) were sustained up to the 1-month follow-up. The within-group data analysis produced statistically and clinically significant changes from baseline to the 1-week flow-up across all outcome measures. Post hoc power analysis and sample size calculations suggest that the average between group power of this trial was approximately 60% (ES = 0.33) and that a definitive trial would require a minimum of 102 participants per group ( N = 204) to achieve satisfactory power of ≥80%. Conclusions The trend in results of this trial suggest that an innovative structured protocol of manual and manipulative therapy (experimental group) is equivalent to standard care of a night splint(s) (control group) for symptomatic mild to moderate HAV in the short term. The protocol of MMT maintains its treatment effect from 1-week to 1-month follow-up without further treatment, while patients receiving standard care seem to regress when not using the night splint. Insights from this study support further testing of MMT for symptomatic mild to moderate HAV, particularly where surgery is premature or where surgical outcomes may be equivocal, and serve to inform the design of a future definitive trial.

Forefoot Pain In A Cross Country Runner

HISTORY An 18-year-old college freshman cross country runner with about one month of plantar surface left great toe pain. Pain initially started in her medial longitudinal arch. Seen by a physical therapist who found decreased range of motion of the great toe and initiated a stretching program. Within a couple days, the arch pain resolved and she developed pain beneath her great toe. The pain consistently increased until it was constant, even while walking. At time of maximal pain, she was running about 50 miles per week. She began using a donut cutout and elastic tape to relieve pressure at the plantar first metatarsophalangeal (MTP) joint. The pain improved while running and occurred only with palpation and without taping. Denied previous history of this type of pain. Regular menses. Diet appropriate upon review. Denied history of eating disorder or disordered eating currently or in the past. PHYSICAL EXAMINATION Examination of the left foot about 1 month after onset of symptoms: Inspection revealed bilateral pes cavus and significant callus formation at plantar first MTP joint. No obvious swelling. No skin discoloration. Exquisite tenderness to palpation at the plantar first MTP joint. Active and passive extension of the great toe was decreased by about 15–20 degrees compared to the right great toe. Flexion was equal bilaterally. Strength was within normal limits. DIFFERENTIAL DIAGNOSIS Sesamoiditis Sesamoid stress reaction or fracture First metatarsal stress reaction or fracture First MTP joint synovitis Flexor hallucis longus tendonitis TEST AND RESULTS Left great toe anterior-posterior, lateral, oblique radiographs: two foci of calcification just plantar to tibia sesamoid beneath the first metatarsal head no sign of fracture of sesamoid or any other bone or soft tissue abnormality FINAL WORKING DIAGNOSIS Flexor hallucis longus calcific tendonitis TREATMENT AND OUTCOMES Modified training/cross training. Continued use of donut cutout and elastic taping. Iontophoresis to the affected area. Orthotics prescribed and obtained with special cutout below great toe. Able to run without difficulty and pain only present with direct palpation or when not wearing orthotics.

Acute Coronary Ischemia Following Centipede Envenomation: Case Report and Review of the Literature

This is the first known case report of electrocardiographic (ECG) changes suggestive of coronary vasospasm following a centipede envenomation. A 60-year-old man presented to the emergency department (ED) 1 hour after being stung by a 12-cm centipede. He complained of right great toe pain that did not radiate to his leg. The patient had no known ischemic heart disease. He did not describe any exertional symptoms but admitted experiencing weakness. During the ED course, concurrent with obtaining peripheral intravenous access, the patient experienced diaphoresis, dizziness, hypotension, and bradycardia. His ECG showed new ST-T wave changes, which suggested an acute ischemic process. The patient's blood pressure was 89/60 mm Hg, his pulse rate was 47 beats/min, and his respiration rate was 28 breaths/min. In the following hours, ECG findings returned to baseline. His blood pressure improved gradually with fluid resuscitation after approximately 5 hours. Cardiac markers returned to normal in the 13th hour after the event, and the patient underwent exercise stress testing, which was negative. The patient was discharged with cardiology follow-up. Adult patients with centipede envenomation should be closely monitored in anticipation of possible myocardial ischemia due to vasospasm, hypotension, and myocardial toxic effects of the venom. A child receiving the same amount of venom would be potentially at greater risk.

Aesthetic and Functional Thumb Reconstruction: Great Toe to Hand Transfer

“Turf toe,” originally described in literature by Bowers and Martin in 1976, is an injury to the capsuloligamentous complex of the first metatarsophalangeal joint. This injury is common in football players. Up to 45% of National Football League (NFL) players have suffered from turf toe during their professional career. Turf toe injuries have been attributed to playing on hard, artificial surfaces with soft, flexible cleats; 83% of the turf toe injuries occurred on artificial turf. For most turf toe injuries, nonoperative treatment is the preferred approach, even in some cases with associated fracture of the sesamoids. Operative intervention should be considered after nonoperative management has failed or in cases of clear instability or sesamoid retraction. Good functional outcomes with high rates of return to play can be expected with appropriate management. Despite this, persistent symptoms of stiffness and great toe pain are not uncommon following initial injury, surgery or both. Due to limited availability of high-level evidence regarding the outcomes of turf toe injuries, particularly for surgical management of high-level athletes, this article will combine what is available with level V evidence based on the senior author’s experience over 34 years and his discussions with other experts in the unique subspecialty of foot and ankle sports medicine.

A CASE OF DISLOCATION OF PROXIMAL PHALANX OF GREAT TOE

P. W., male, white, laborer, aged 56, reported at the surgical outpatient department of the University Hospital, service of Dr. B. A. Thomas, May 28, 1913, with the history of having been kicked by a horse nine weeks previously, and of having been treated at another hospital for an injury to the left knee. He now complains of pain in great toe. Examination reveals fixation of great toe in extreme extension and crepitation at metatarsophalangeal joint. The roentgenogram (Fig. 1) shows displacement of proximal phalanx of hallux onto the dorsum of the head of its metatarsal. The antero-posterior view (Fig. 2) is of interest in showing concomitant displacement of the sesamoids from the plantar aspect to each side of the joint. Under nitrous oxid reduction was attempted by means of Levis' apparatus, but owing to laceration of the skin this method was abandoned. A trial was next made of the