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205 Cards in this Set
- Front
- Back
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where does achilles tendon usually rupture |
5-7cm proximal to insertion into calcaneous |
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who does achilles tendon rupture usually affect |
middle aged men who play quick, stop and go sports (tennis, basketball) |
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how will one describe achilles tendon rupture |
- severe calf pain, that can resolve quickly - gunshot wound or direct hit from racquet |
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what is achilles tendon rupture often dx as |
- ankle sprain |
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PE of achilles tendon rupture |
- swelling on lower calf - difficulty bearing weight - sometimes palpable tendon defect - refer w/in 24 hr if sudden pop w/ pain and swelling in calf - thompson test |
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what is thompson test? what pathologies might it indicate |
- pt prone w/ knee extended or flexed angle at 90 deg - squeeze calf (if no defect results in passive plantar flexion of ankle) - pos test = absence of plantar flexion - anchilles tendon rupture |
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what might you see on XR of achilles tendon rupture |
- Kager triangle |
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AE of achilles tendon rupture |
- weakness during stance phase of gait - loss of power w/ push off (athletes) - feel if walking on sand beach |
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TOC achilles tendon rupture |
- bulky jones posterior ankle splint and crutches (foot in plantar flexion) - elevate above heart first 48 hrs, review signs of DVT - surgery for young, healthy active pt - PT therapy, 6-9 mo of rehab |
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MC mechanism of injury for ankle sprain |
- ankle inversion (stresses lateral ligamentous stabilizers) |
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classification of ankle sprain |
- grade I: mild - grade II: mod - grade III: severe |
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describe grade I ankle sprain |
- micro tear - mild pain - delayed edema - recover 1-2 wks |
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describe grade II ankle sprain |
- partial tear - immediate disabling pain and swelling - later ecchymosis - recover 4-8 wks |
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describe grade III ankle sprain |
- complete tear - immediate instability and swelling - large ecchymosis - recovery 6-12 wks |
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what will severe ankle sprain present |
- "pop" - immediate swelling - inability to walk/ bear wt |
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how are lateral ligaments of ankle sprain ALWAYS injured |
- injured from anterior to posterior - ATFL, CFL, or PTFL |
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MC lateral ligament injured in ankle sprain |
- ATFL always injured first |
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what indicated a subtalar joint injury (ankle sprain) |
- TTP over Sinus Tarsi - ecchymosis over medial aspect of heel |
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what suggests a fracture in ankle sprain |
- TTP or crepitus over medial/lateral malleoli or base of 5th MT |
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2 tests that evaluate tibiofibular syndesmosis injury |
- Squeeze Test - External rotation test (pos is increased pain on passive ext rotation of ankle) |
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2 PE tests that reveal which ligament has been disrupted in ankle sprain |
- anterior drawer (ATFL) - Talar tilt test (combined injury of ATFL and CFL) |
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what is maisonneuve's fracture |
- prox fib fx, tear of medial deltoid ligament, disruption of tibiofib syndesmotic ligaments - caused by UNSTABLE EXT rotational injury where force transmitted proximally thru syndesmotic ligaments |
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what fractures must you r/o in ankle fx |
- proximal fibula fx (Maisonneuve's) - use Ottawa ankle rules |
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what are Ottowa rules? (5) |
ankle XR required if... 1. TTP at post tip of lateral malleolus 2. TTP at post tip of medial malleolus 3. inability to bear wt at time of injury or time of exam foot XR required if 4. TTP base of 5th MT 5. TTP at navicular bone |
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XR series for ankle |
- anterior draw stress XR - talar tilt stress XR |
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TOC of ankle sprain |
- RICE - bracing - PT - cast in pt w/ severe pain and swelling, esp if 1st time injury |
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when might surgery be considered for ankle sprain |
- chronic ankle sprain due to ankle instability that is refractory to non-op management |
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when are ankle sprains referred |
- fx - tear or sublux of peroneal tendon - chronic/ recurrent sprain - failure to improve 6 wk, esp OCD talar dome - nerve injury |
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signs of arthritis in first MP joint |
- loss of dorsiflexion - swelling great toe joint/ hallux rigidus |
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who commonly gets midfoot osteoarthritis |
- older pt - pt who had previous Lisfranc dislocation |
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s/s of midfoot osteoarthritis |
- pain midfoot - worsen w/ walking or standing - difficulty pushing off with foot - dorsal bump on palpation |
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where is pain in subtalar arthritis? what previous injury often causes it? |
- pain below medial malleolus and distal fibula - difficulty walking on uneven surface (eversion and inverse effected by arthritis) - often result of calcaneal fracture |
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what arthritis of foot do you see loss of inversion and eversion |
- talonavicular or talocalcaneal arthritis |
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how do patients with ankle arthritis usually walk? |
with leg externally rotated |
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on XR where is midfoot arthritis most evident at? |
- 2nd tarsometatarsal joint |
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best view for talonavicular arthritis on XR |
- AP |
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best view for talocalcaneal arthritis on XR |
- lateral view |
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TOC for foot/ ankle arthritis |
- NSAIDs, corticosteroids - shoe mod: - stiff soled w/ rocker bottom (hallux rigidus) - steel sole orthotic: mid foot arthritis - medial longitudinal arch support, rigid orthoses: talonav/subtalar arthritis |
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TOC for foot arthritis that is REFRACTORY to non-op management |
- midfoot fusion for mid foot - subtalar arthrodesis/fusion for subtalar *if chronic, surgical fusion*
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ddx for foot arthritis |
- acute onset w/ no hx of trauma: stress fracture |
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what is bunionette? |
- deformity of 5th MP joint that is analogous to a bunion deformity of great toe - prominence of lateral aspect of 5th metatarsal head and medial deviation of small toe |
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cause of bunionette |
freq wearing of tight, narrow and pointed shoes |
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TOC of bunionette |
- selection of proper shoes - medial long arch support (take pressure off bunionette) - modified metatarsal pad - cont'd sxs: excision |
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what is a callus |
- hyperkeratotic lesion of skin, forms in response to excessive pressure over a bony prominence |
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what is a corn? |
- a callus that forms on a toe |
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what is a persistent callus on sole of forefoot also referred to as? |
- intractable plantar keratosis |
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sxs of corns/ calluses |
- seen on PE |
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deformities caused by improper shoes |
- corn/ calluses - bunionette - hammer toe - claw toe |
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heoma durum |
- hard corn - develop over bony prominences |
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heloma molle |
soft corn - develop btw toes in web space |
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how are warts and calluses distinguished |
- app and palpation - callus: uniform waxy app - callus/corn: tender w/ direct pressure - wart: tender when pinched from side to side |
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where do plantar warts usually NOT develop |
- over bony prominence |
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TOC for corns/callus- |
- paring (shave layer by layer w/ scalpel w/o drawing blood) - self care: pumice stone or callus file - pressure relief (lamb wool for soft callus) - correct initial problem (improper shoes) |
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TOC for plantar wart |
- topical salicytic acid or liquid nitrogen |
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when to refer corn/ callus |
- ulceration or infxn - deformity |
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what is charcot arthropathy |
- progressive musculoskeletal condition - characterized by joint dislocation, fractures, deformities - caused by diabetes |
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primary etiology of diabetic foot |
- peripheral nerve impairment - don't feel trauma |
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what predisposed diabetics to skin ulceration |
- dry, scaly and cracking skin - tight shoes |
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what must you worry about in deep infxn of diabetic foot |
- osteomyelitis |
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what is charcot arthropathy often misdx as (3) |
- cellulitis - osteomyelitis - gout |
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s/s of charcot arthopathy |
- swelling, warmth, redness - NO/mild pain - pulses usually strong - when elevated above heart (1min) lose redness |
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couseling of diabetic patient |
- monofilament on exam - protective foot care and well cushioned shoes - controlled BG |
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what is failure on monofilament exam |
- failure to feel at 4 out of 10 sites |
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PE of diabetic ulcers |
- probe for depth/size - if touch bone think OM |
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best exam test for charcot foot |
- elevate above heart for 1 min - if lose its redness: charcot - if not: think cellulitis, abscess or OM |
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w/u of diabetic foot |
- XR - vascular studies if pulses absent or non-healing ulcer - can do bone scan in difficult case of charcot vs OM |
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is neuropathy of diabetic foot reversible |
NO |
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treatment of deep infxn/ ulcer in diabetic foot |
- aggressive/ prompt - abx (via bone iopsy) |
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TOC for abscess |
- emergent - I&D |
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TOC for osteomyelitis |
- debridement of affected bone - may need amputation (toe or metatarsal) |
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Treatment for charcot |
- initial: unweighted, cast stabilization - after swelling subside: bear wt, clamshell short leg brace (12 mo immobilization) |
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define stable ankle fracture |
- only ONE side of joint involved (e.g. fx of distal fib w/o injury to medial deltoid ligament) |
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define unstable ankle fx |
- BOTH sides of ankle joint involved - called bimalleolar or trimalleolar |
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what is danis- weber classification |
used for fx of ankle for txt choice - based on level of fib fx |
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1 classification systems for ankle fx- |
- danis weber - lauge-hansen |
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danis-weber AO classification |
Type A: fib fx below syndesmosis Type B: fib fx at level of syndesmosis Type C: fib fx above syndesmosis |
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TOC for type A ankle fx- |
- closed reduction w/ casting |
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TOC for type B ankle fx |
- same as A, unless syndesmotic disruption - if disruption ORIF |
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TOC for type C ankle fx |
- ORIF |
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what is bimalleolar fx |
- fx of lateral & medial malleolus OR - fx of distal fib w/ disruption of deltoid ligament |
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what is trimalleolar fx |
- includes fx of posterior malleolus |
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what might you see with a trimalleolar fx |
- posterior dislocation of ankle |
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possible PE findings on ankle fx |
- marked tenderness - palpable gap (medial side) - lat displacement or ext rotation |
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what is a PE finding of an unstable bimalleolar injury |
- fx of distal fib (lat malleolus) with TTP over medial deltoid ligament |
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XR series for ankle fx |
- AP, lat and mortise (15 deg internally rotated AP) - always repeat in 10-14 days (check minimally displaced) |
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best view to see shear or osteochondral fx of lateral articular surface of talus |
- mortise |
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TOC for stable ankle fx |
- wt bearing cast or brace 4-6 wks |
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tOC for unstable ankle fx |
- if NON-displaced, non-wt bearing short or long leg cast, longer immobilization - Diplaced: *ORIF* or closed reduction |
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treatment of ankle fx if concomitant dislocation |
Reduce asap for pain and neurovasc relief |
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TOC for open fractures (all) |
- Surg (debrid, possible ORIF) |
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what is Jones fracture |
- zone 2 fx of proximal diaphysis of fifth MT |
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TOC MT fx |
- non-displaced: non-op - short leg cast, fx brace or wooden soled shoe |
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TOC for Jones fx/ zone 2 MT fx |
- ext immobilization - non-wt bearing 6-8 wks w/ short leg cast |
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what might a zone 3 MT fx result in? TOC? |
- nonunion or delayed union and prodromal sxs exacerbated by inversion injury - surgery |
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stress fx think.. |
- new activity or new training regiment (inc in intensity or training) - change running surface - prolonged walking |
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XR series for MT fractures |
- AP, lat, oblique |
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w/u for fx |
- XR - Bone scan (stress fx) |
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which MT fx is usually result of high impact and may require surgery |
- 1st MT |
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zone 1 MT fx |
- avulsion fx at base |
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zone 2 MT fx |
- prox diaphysis/metaphyseal fx |
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zone 3 MT fx |
- shaft fx (surgery) |
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AE of treatment of MT fx |
- malunion w/ painful plantar callus under MT heads - dorsal corns caused by friction over prominent MT head |
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referral decisions for MT fx |
- multiple - > 10deg angulation - prox 5th MT in zone 2 or 3 - displaced/comminuted of 1st MT - open fx |
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what is Lisfranc injury |
- fx-dislocations of midfoot |
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what can Lisfranc injury cause |
- traumatic disruption of tarsometatarsal joint - OA - midfoot deformity |
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critical injury of Lisfranc? Why? |
- involves 2nd tarsometatarsal joint - keys into slot in cuneiforms stabilizing apex for all other tarsometatarsal joints |
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Pe exam for dx Lisfranc |
- stabilize hindfoot (calcaneus) and rotate and/or abduct forefoot w/ other hand - severe pain = Lisfranc - minimal pain = ankle sprain |
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XR w/u of Lisfranc |
- ap, lat, oblique - if normal but PE suggest Lisfranc try stress XR - CT or MRI if need to confirm dx |
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TOC lisfranc- |
- non-displaced 6-8 wk non-wt bearing cast immobilization - followed w/ rigid arch support for 3 mo - displaced (even if minimal): surg |
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2 bones of hindfoot? how are they MC fx'd? how does fx occur |
- calcaneus and talus - severe trauma (MVA, fall from ht) - seldom occur together, most intra-articular and serious |
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nerves assessed in hindfoot fx |
(distal to fx) - sup peroneal - deep peroneal - sural - medial & lat plantar |
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w/u of hindfoot fx |
As always sensory, motor, neurovasc - if no pulses, try cap refill - palpate spine (fall fx) - XR: AP, lat, mortise, spine (if TTP) |
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AE of hindfoot fx |
- if talar neck: disrupted blood blow cause osteonecrosis to talus - OA - tarsal tunnel syndrome |
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TOC of hindfoot fx |
- immediate post splint or jones dressing - elevate ext level of heart, ice applied for 20 min q 1-2 hr - ORIF |
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MC affected toe phalange fx |
- fifth/ little toe |
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w/u of toe fx |
- AP for confirm (only one needed) |
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TOC phalange of toe fx |
- buddy tape - consider pin, closed reduct or ORIF for angulated fx or intra-articular fx (send for ortho consult) |
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what is hallux rigidus |
- OA of MP joint of great toe - MC arthritis in foot |
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w/u of hallux rigidus |
- hallmark: stiffness of GT w/ loss of ext at MP joint - pain as toe moves into dorsiflexion - XR: ap and lat (fairbanks signs)
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tOC hallux rigidus |
- shoe w/ large toe box - stiff soled shoe w/ steel shank or rocker bottom (dec dorsiflexion) - NSAIDs, RICE, steroids - surg: osteophytes or fusion |
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what is hallux valgus |
- lat deviation of GT at MTP joint - can lead to bunion: painful prominence of medial aspect of 1st MT head |
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hallux valgus MC in? |
- Females |
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w/u of hallux valgus |
- PE: hypertrophic bursae over medial eminence of 1st MT (often present), GT pronated w/ callus on medial aspect - assess valgus angulation at MP joint (AP XR) - measure ROM (norm: ext 60 deg, flex 30deg) |
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normal valgus angulation at MP joint |
< 15 deg |
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how is bunion severity assessed |
wt-bearing AP XR (measure IM and HV angle) norm hallux valgus < 15deg norm IM (interMT) angle < 10 |
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TOC bunion |
- education, proper shoe wear (avoid high heels) (No other txt indicated if asymptomatic) - surgery: disabiling sxs, cosmetic at pt request |
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types of surgery for bunion |
- joint capsule cut - add hallicus tendon cut - bone wedge removed - pinning - joint capule tightened - proximal osteotomy |
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what happens with ingrown toenail |
- distal margin of nail grows into adjacent skin - causes irritation, inflammation, possible 2ndary infxn - usually on GT |
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what is ingrown toenail assoc with |
- improper toenail trimming - tight shoes - subungual patho - trauma - hereditary |
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how to properly trim toenail |
- cut straight across to keep lateral margin of toenail beyond nail fold |
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sxs/ stages of ingrown toenail |
- Stage 1: induration, swelling, tender - Stage 2: abscess (drainage, tender, red) - Stage 3: granulation (less pain, granulation tissue grown onto nail plate, inhibit drainage)
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when might you order an XR for ingrown toenail |
- Stage II or III to r/o subungual exostosis and osteomyelitis |
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TOC for stage I, ingrown toenail |
- warm soaks, proper nail trim, mod shoe wear(non-constrictive/ sandals), clean socks - insert cotton or waxed dental floss under nail to lift edge of nail from embedded position - exchange daily packing until nail grown out sufficiently |
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TOC for stage II, ingrown toenail |
- foot soak w/ oral abx - if severe pain: partial nail excision - if avulsed nail: require 3-4 mo regrow |
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TOC for stage III, ingrown toenail |
- partial or complete nail plate excision - with or w/o ablation of germinal matrix |
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what is metatarsalgia |
- forefoot pain localized under one or more of lesser metatarsals |
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causes of metatarsalgia |
- abnl MT length - toe deformities (claw/hammertoe) - callus or intractable plantar keratosis |
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w/u of metarsalgia |
- PE, ROM - note calluses, deformities - XR (ap and lat) for alignment of toes |
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treatment of metatarsalgia |
- mod shoes, MT pad or orthotic - shave if callus - consider surg if toes misaligned or txt non successful |
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what is morton neuroma |
- plantar interdigital neuroma - perineural fibrosis of common digital nerve as it passes btw MT heads NOT a true neuroma |
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MC area for morton neuroma? less common areas |
MC: btw 3rd and 4th toes (3 web space) less in 2nd web space (btw 2nd & 3rd toe) rare first or fourth web space |
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s/s of morton neuroma |
- plantar pain in forefoot - dysethesias in affected area or burning plantar pain aggravated by activity - feel as if "walking on a marble" or "wrinkle in my socks" - pain relieved by rubbing ball of foot |
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what is consistent with inter metatarsal neuroma |
- isolated pain on plantar aspect of web space |
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TOC metatarsal neuroma |
- avoid high heels - use MT pads - lidocaine w/ steroid injection - surg if persistent sxs |
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MC bugs that cause onychomycosis |
- trichophyton rubrum and t mentagrophytes |
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MC pt of onychomycosis |
- 50% older than 70 |
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w/u of oncyhmycosis |
- thickened and chalky white/ yellow nail discoloration - KOH prep |
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TOC nail fungus |
- periodic nail trimming - oral meds: itraconazole, fluconazole, ketoconazole and terbinafine - do LFTs if put on meds |
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where does plantar fascia arise from and extend to? |
- arises from medial tuberosity of calc extends to prox phalanges of toes |
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what is function of plantar fascia |
- support foot as toes extend during stance phase of gait - it is tightened by a windlass mechanism, resulting in elevation of longitudinal arch, inversion of handoff and resultant ext. rotation of leg |
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MC cause of heel pain in adults |
- plantar faciitis |
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etiology of plantar fasciitis |
- degenerative tear of part of the fascial origin from calc, followed by tendinosis-type reaction - leads to chronic degenerative change in fibers of plantar fascia |
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typical plantar fasciitis patient |
- women - overweight people |
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is plantar fasciitis associated with a particular foot type |
NO |
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PE and w/u of plantar faciitis |
- TTP over medial calc tuberosity and 1-2 cm distally along plantar fascia - pain more severe on awakening or when rising from resting position - may have achilles tightness - heel spur in origin of flexor brevis - XR not necessary unless giving steroids |
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Treatment plantar fasciitis |
- 95% managed w/non op txt (take 6-12 mo for sxs to resolve) - orthotics (heel pad, night splint), stretching exercises - RICE - steroids if pt has sxs 6-8 wks of non op txt - sure release only if 6-12 mo of INTENSE non op txt failure |
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AE of plantar fascia txt |
- fat pad necrosis if steroids used |
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cause of plantar warts |
- papillomavirus |
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what is mosaic warts |
- cluster lesions of plantar warts |
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PE of plantar warts |
- usually appear non-wt bearing area of sole - no papillary lines of skin on it - TTP when pinched side to side - superficial paring of wart reveals punctate hemorrhage and fibrillated texture |
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txt of plantar warts |
- only aggressive if large, painful or persistent lesions - intial txt: superficial paring, keratolytic agent (salicylic acid or Mediplast)2x daily q 1 mo, covered w/ moleskin or duct tape - cautery or liquid nitrogen |
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4 causes of posterior heel pain |
- insertional achilles tendinitis - retrocalc bursitis - Haglund's sydnrome - pump bump |
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what is haglund sydrome |
- prominent process of calc impinging on achilles tendon - leads to pump bump - in later years: insertional tendinitis and calcification & degenerative tears of achilles tendon |
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what is pump bump |
- inflammation of bursa btw skin and achilles tendon |
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sxs of Haglund's sydnrome |
- start up pain, pain after activity, pain w/ shoe wear - limp - TTP, swelling on post heel, prominence esp on lat side of heel |
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what will you see on PE of retrocalcaneal bursitis |
- pain ant to achilles tendon that increased by squeezing bursa from side 2 side and just ant to achilles tendon |
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XR of posterior heel pain |
may see - calcification of achilles tendon - spur formation - prominent posterosuperior process of calc |
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TOC for posterior heel pain |
- heel lift, open back shoes - RICE - achilles tendon stretching exercises if there is equinus contracture - surg remove prominence/ dz tendon |
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what is posterior tibial tendon dysfunction? typical pt? |
- primary cause of medial foot/ankle pain in middle aged pt - overwt women > 55 yo, also assoc w/ steroids, DM, and HTN
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PE and w/u of posterior tibial tendon dysfunction |
- loss of arch/ flatfoot - TTP and swelling on medial aspect of ankle - ankle rolls in (hindfoot valgus w/ forefoot abduction) - XR |
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test for posterior tibial tendon dysfunction |
- view from back = too many toes - toe rise on 1 leg, post tib tendon can't perform or normal inversion of heel doesn't occur |
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XR findings of post tib tendon dysfunction |
- flatfoot - changes in talonavicular and other joints |
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TOC for post tub tendon dysfunction |
- NSAIDs - short leg cast or brace for 4 wk - once cast removed, molded ankle-foot orthosis - medial heel wedge or medial long arch support for flatfoot NO injections - if rigid flatfoot: arthrodesis |
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bone deformities seen in RA of foot and ankle |
- hallux valgus - claw toe w/ subluxed or dislocated MP joints - arthritis of ankle, talonavicular, or subtalar joint |
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last joint to be involved in RA |
- ankle joint |
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MC presenting complaint of RA of ankle/foot |
- metatarsophalangeal synovitis - pain over MP joint (think RA if bilateral, multiple joints, nodules, etc |
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w/u of RA |
- inc ESR and RH factor - XR: erosions, osteopenia, lateral drift |
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RA txt |
- methotrexate - steroid injections - shoe mod, orthotics - if severe of hindfoot: triple arthrodesis required |
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where are sesamoids found? what are disorders found? |
- embedded in flexor hallicus brevis tendon beneath 1st MT head - inflammation, fx, arthritis |
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cause of sesamoditis |
- repeated stress leads to inflammation - (dancing, running, trauma from fall, forced dorsiflexion of great toe) |
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PE and w/u of sesamoiditis/ sesamoid fx |
- TTP that moves w/ sesamoid as GT is flexed and extended - XR: ap, lat, axial, oblique (if fx) |
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normal variant of sesamoid bones |
- bipartite or multipartite sesamoids |
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TOC for sesamoid fx |
- stiff soled shoe or removable leg brace - change to wide toe show at 4 wk - j shaped dancer pad after fx healed and back to everyday shoes - if severe: tape toes or excise |
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MC soft tissue tumors of foot/ ankle |
- ganglia and plantar fibromas |
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what is plantar fibroma |
- benign thickening of plantar fascia - may evolve to plantar fibromatosis (nodular fasciitis, like Dupuytren's dz) - less likely to cause deformity |
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PE and w/u of plantar fibroma and ganglion cyst |
- fibroma: firm mass on bottom of foot - ganglia: soft mass, moveable |
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txt of ganglion |
- needle decompression - surgery if recurrent |
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txt of plantar fibroma |
- shoe mod, orthotics - surg if large or persistent sxs |
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who at greatest risk for stress fracture |
- young, women athletes (triad) - elderly women: osteoporosis |
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MC area of stress fracture in foot/ ankle |
- metatarsals (esp 2nd MT) |
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when will bone scan be pos for stress fx? how about XR |
- bone scan: 5 days - XR: 3-4 weeks |
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which stress fx must be casted? which must have internal fixation? |
- cast: navicular and 5th MT fx - IF: 5th MT, zone 3 injury |
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what is tarsal tunnel sydrome |
- compression neuropathy of post tibial nerve or its branches post to medial mall |
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PE and w/u of tarsal tunnel sydnrome |
- parethesias or dysthesias along medial ankle and into arch - weakened toe flexion - TTP post to medial mall, pos Tinel - XR, MRI and even electro testing may be normal |
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treatment of tarsal tunnel syndrome |
- orthotics - surg release usually fail, lead inc sxs |
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causes of toe deformities |
- improper shoes - imbalance of intrinsic (leg) and extrinsic (foot) muscles |
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what is claw toe deformity |
- EXT of MP joint - FLEX of PIP joint |
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what is hammertoe |
- FLEX of PIP joint - with no deformity of DIP or MP joint |
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what is mallet toe |
- FLEX of DIP joint - normal PIP an MP joint |
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MC toe affected in hammer and mallet toe |
- 2nd toe |
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when are XR indicated in toe deformities |
- if planning for surgery or r/o osteomyelitis |
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TOC of toe deformities |
- shoe mod - if corns or callus: txt - surg: not for cosmetic but alignment of toes for shoe wear |
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what is turf toe |
- sprain of 1st MTP joint mc occur w/ hyperEXT injury or any forced ROM |
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grading of turf toe |
grade 1: stretch injury of capsule grade 2: partial tear of plantar ligament complex of MP joint grade 3: complete tear of MP ligament complex (can't walk normal or participate in sports) |
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TOC of turf toe |
- RICE - Grade 3: wt-bearing immobilizaiton 1-2 wks, 4-6 wk rest from sports, tape or orthotic devices |
