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| X1 Turf Toe Blade |
Foot Injuries: Turf Toe, and Gout
Turf toe, or a sprain of the ligaments of the first metatarsal
joint, or the big toe, got their name thanks to the popularity of
football. These injuries became more common when artificial turfs were
used to replace grass. Any sports fan has heard of one, and has perhaps
cursed at his favorite athlete for sitting out a month or more of a
crucial season, sitting on the sidelines and looking like a million
bucks, smiling, laughing, perhaps. Could this diva really be refusing
to play for something as teeny as a toe injury? The injury occurs when
the big toe is placed under pressure while bent at an extreme angle.
This can happen when a large players fall on top of one another, are
bent in difficult positions during a tackle, or just pushing off to
accelerate quickly. The injury can happen on grass, or on rock, and is
certainly not limited to football men. Martial arts fighters, climbers,
and any other sort of athlete can be at risk for these injuries
whenever the foot is bent and pressure is on that joint. These injuries
can take months to heal, and attract future trauma, becoming lightning
rods for re-injury. I know from experience, and am posting this so that
any mountain men out there trying to diagnose foot pain can possibly do
so faster than I could this spring. I am no doctor, and will not
pretend to be one. I am not going to copy and paste information you can
pull up for yourself and tie up the SP server with it, nor is this
meant as a stopping point for those interested in this injury. This is
an introductory brief article to get people on the right track. I am
including some external links at the bottom, but do not think these are
the only ones or the best ones. They are a pretty arbitrary choice I
rounded up in under 15 minutes, most of which I found during previous
searches and remembered as being helpful. Hey, I'm not getting paid for
this, and I can't know how many or few people will even be interested
on this topic. I'm just trying to be helpful, I'm not "running for
Jesus."
Background
I turned 29 in January (of 2013) and proceeded to fall apart. I caught colds, a couple flu viruses, got food poisoning for the second time in a few months, had a throat infection, and mystery pain in my feet. This mystery pain eluded home remedies and diagnoses, until by sheer elimination I stumbled (pun intended yes) upon gout. Gout, that disease of Henry the Eighth and other corpulent wealthy deceased celebrities and nobles without will power or sense, that disease of the excessive, who can't figure out when to put the fork or the salt shaker down. Or so I thought. But I am not corpulent or wealthy and as yet, not all that old, and still, I had gout symptoms. All of them. I had burning red swollen feet so hot and itchy I could not sleep, and stiffness in some toes.
Turns out gout is a metabolic disease that can "appear" or "announce" itself in one through symptoms at any time. It is aggravated by trauma (which can include plenty of hiking or climbing or injury) and diet. I was effectively on the all-gout diet the week it first exploded badly underneath me. I cooked a delicious pot-roast chili with butternut squash, ate some steamed cauliflower, had plenty of oats, butter, chocolate, and finally got around to an experimental mushroom bisque with a port wine base. All these things were delicious, but they also all happen to provoke gout. Well, a half dozen dried cherries daily for the remainder of my life is no ferocious medicine. I like the things heartily enough. All of this is preamble and I will rush to the point. The point is, I spent 4 months laid up in what should have been a typical winter of training and prepping my body for plenty of outdoor fun.
I was out of shape, behind schedule, and thus, an eager boy to get going. When I finally caught a few weeks of health and a wealth of fine spring Utah weather, I was on my way to Zion. Alas, this is not a happy ending kind of story. I spent 3 days going through slot canyons and scrambling up slick rock domes, taking in views and sun, basking in both and my own strength and vigor again, ready to turn a corner. That third day I made such quick work of a pip of a peak whose name eludes me, that I jogged over to the Zion Canyon Overlook Trail, a breezy single mile, to try my luck at the East Temple loop route described by the famous Tanya and Bo Beck on their website (seriously, I ran into a German that very day who started talking to me about the dark-haired woman and a thin man with a great web page describing all the best routes in the park). At the overlook, a huge group of teenagers hanging on the railing kidded each other about climbing this or that and placing bets and talking big gave me some looks clearly enough barbed with, "oh great, a dinosaur is here! I hate old people! What bores." Or some such thing. Well, I went off into my own little realm, casually changed into sticky rubber tight climbing shoes, threw on some gloves, took a little swig of water, and then, without a word, as if they were not there, but aware of them all the time, of course, began the bouldering and scrambling up the steep slabs, aiming for white domes far overhead.
Hubris was my downfall. I showed off for those kids, and for myself. It was not enough to just do the route. I wanted to conquer this thing, to make it the simple undertaking it should be, to shame the whole mountain, the whole park, as if I were trying out for the Olympics. I wanted to hit 3 home runs with one swing, as I once heard Sammy Sosa's approach to baseball described (back before the corked bat and steroids, when he was still a beloved big kid at heart who sometimes fell down from swinging so hard). I made tremendous speed. I bounded, leapt, flew up rock, sprang and crawled like a sticky little spider. In five minutes the group far below was a cluster of specks. Making out faces or words was obviously impossible, but I consoled myself and my vanity that most of them were watching me, pointing, marveling. Who cares if it were true, I could almost believe it! I breathed hard, but I laughed. I had done nothing in months and now I was healthy, about to launch the greatest summer of my life. Only my right foot was hurting. I took some breaks, moved the toes around, sat when I could, shook the foot. But each move, and each vertical step, that foot just throbbed more. You have probably had this sort of problem: you are only vaguely aware at first you are in pain, then you begin to analyze the thing, to know you are injured, and yet you keep moving, as if momentum will protect you, as if you can outrun it, the way seeing a train behind you, speeding up might prevent a crash, being run over. Well, okay, I said, "these are climbing shoes. They are tight. And too tight now. Remember you have gout." So I changed into my approach shoes. Still no help. I was limping by the time I made it to those domes and looked down the other side. A fifteen minute rest did no good. I finished out the loop because I was almost half done, and because if you are going to get injured, you might as well finish what you started and thought was worth risking your body for, and because things were far more interesting to descend a new way, and because the slabs were less steep, no crowds would be watching as I now made an snail's progress seem advanced. But I could barely walk after I returned to my tent at a local campground, and I knew morning would bring no solution. Improvement, perhaps, but this was not going away in a day.
I hoped it would go away after a week. I drove home. I was a good boy. I rested. But the toe did not get better in a week. Most of the pain was gone. I could walk, but I had no push-off. It felt tired. Not painful, just tired. Sometimes it would get warm or puffy near where the big toe joins the rest of the foot. If I massaged it, it tingled in a sort of way that felt weak. But again, there was no pain. Try telling people, especially those who do not exercise, that you are injured when you can walk just fine and have no pain. I gave it a few weeks and then was back to 80% or more. I could play tennis, as long as it was not a full singles match, constantly frenetic. I could put on heavy hiking boots and go up a mountain. But barefoot I walked slowly and still that joint felt tired. I thought it laughable my foot would hold up to week-long backpack trips or climbs in rock shoes. I was not even willing to attempt such things. So I waited and rested. When rest seemed to do me no more good, I got tough. I told myself the whole thing was in my mind and did barefoot hops, lunges, stair climbs, and full workouts. It would ache, throb just a little.
I do not go to doctors, but I found a podiatrist. This, if you suspect a turf toe injury, is a mistake. A podiatrist wants to sell his clients foot products: custom foam orthotics, for instance. He wishes to discuss discolorations that might be cancerous five years down the line, menacing freckles, pronation, plantar wart surgeries for small blemishes on the soles that might be the start of one, and to hammer home the idea that gout cannot be diagnosed without blood work. Ha, by the way! By that logic, Henry the 8th did not have gout and the disease began to exist in 1954. Of course I can home diagnose gout. I can also home diagnose a sprained big toe, which he would have none of. My foot was fine, I was imagining it, I needed a blood test so gout would not kill me or give me kidney stones, cherries do not work, and more of the same. With a smiling good grace his final conclusion was: "you are fine, I will not give you a foot x-ray, it is not possible to sprain your toe climbing a mountain (I am thinking he was picturing the plastic boots one would go up Mount Everest in which do not bend), and even if you were injured, the solution would be the same: mountains are dangerous, going up them solo is worse, so get married and stay home instead."
If you suspect a big toe injury, such as turf toe, the kind of professional to see is a Sports Medical Doctor. Go to such a professional with a fear of turf toe, and they at least are speaking the same language. You want to know what to do to be back "in the game" as soon as possible, this makes sense to them. They don't lecture or break out stories about how cerebral cortices only fully solidify and seal in the middle 30s for most people, meaning that youngsters are incapable of evaluating risk verses reward and that for that reason, young people should listen to their elders and stop climbing mountains (or doing any other activity you like, but which your parents do not want to hear about). They will likely tell you what your limitations will be, what your eventual time-table is for full health, and what products and tricks you can use to prevent further injury. That is all I wanted. And the inability of a jolly chubby charming-enough fellow to hear me or do what I wanted when I am the customer is why I do not go to doctors. My previous experience, as if any of you care, was for terrible vague knee pain, which I eventually decided was tendinitis caused by my hamstrings getting weak after I quit heavy weight lifting (in a surprise, mountain hiking made my knees better!), which a doctor dismissed, with the odious attitude that I was some junkie trying to lie my way to a pain-pill prescription from him. Condescending: the whole brood of them!
Dealing with Turf Toe
I will be darned if the most useful break I had in my sleuthing did not come from a Mixed Martial Arts Web Forum. Yes, discussions on the Internet can be productive and without negativity! Even among violent meatheads! Finally I got that sense of empathy: big bad-ass fighters were all moaning to one another about the slow process of waiting out a big toe sprain, and being mocked by training partners and opponents as wimps. The conclusion of many: there is nothing worse than a sprained big toe.
I do not think I will go that far. I'd rather sprain my toe than shatter my leg, for instance. But it often seems like it. A turf toe injury can be 4 severities of damage. The 4th stage requires surgery and could not possibly be missed by even the worst podiatrist in the world. They are the human equivalent of a blown tire. Your toe may be horribly bent, there may be blood, bone sticking out, a huge black and purple bruise, swelling to puffer fish frightening proportions. But the other three are largely invisible and as a tire on your car may have a leak you can't spot or be wearing thin, without notice, these are harder to diagnose. A very mild sprain might heal in a week, or more likely in two. You may have had several of these. I may have had several of these. It is likely to go down as foot soreness, and nothing more. A more severe sprain will take a month, and again, you may not know it is a sprain. Nothing is torn, the swelling goes away quickly. You lose a little push off, a little lift. A more severe sprain than that will take two to three months to heal. It depends on the person. The recovery might be six months for 100% return to athletic prowess. Any length in between is just as common. On the MMA board I mentioned, there were fellows who had been dealing with their injuries for four months. Of course, climbing mountains or kicking people in the face is not going to help your toe heal, and will delay the recovery. But one gets impatient, and if summer, is here, summer is here. These more severe sprains can involve tears but usually do not call for surgery. It is unlikely any sane person will go six, four, or even two months with a limiting injury and not manage to get it diagnosed or figured out at some point. Turf toe is common enough that my suspicion is there are more false positives than false negatives. And whether you have a first degree, or a fourth degree joint injury is not nearly as important as recognizing you have one.
Okay, so let us say you have a blown first metatarsal joint, now what do you do? Well, first, get educated. Reading this article does not count. I promise you. Check the external links, find some of your own, go to a doctor if you can stand the creatures. One important fact to understand is that your joint, even once healed, is compromised forever. Your big toe is now a magnet for shock, future injuries, and is a weak link. You may not have to baby it forever, but those carefree days of hardly knowing you have metatarsal joints are gone. Some nights it will tingle, some nights throb. You have the first stirrings of arthritis in that joint (and any other joints you've injured over the years). If you are prone to gout, you now have a "hot corner" which will swell, go red, burn, and get stiff at the drop of a hat, every time you dunk one too many of your favorite cookies into a glass of cool whole milk. (See I was not just wasting time on that gout tangent earlier). More sprains mean an ever stiffer joint, and a big toe that eventually will not bend. (That is one solution of sorts down the line: if the toe can't bend, it can't hurt or get sprained again, right?) I spend whole hours hiking now pondering such deep questions as: "should I be taping my uninjured left big toe MORE than the right, so I can keep it strong and perfect?"
Next, try some RICE (Rest, Ice, Compression, Elevation), a heat pad, and some basic exercises. The link to LiveStrong offers three good ones. I use all three. Water sprints were a favorite exercise before my injury, and they still are. My foot feels better after every swimming session and burst of acceleration under water, where I can't blow out that joint again.
Third, let's talk protective products. Watch the video on athletic taping. By the second effort, you should have it down. Carrying a roll in your first aid kit adds a few ounces, but its better than dragging one leg behind you for five or ten miles, right? There are a slew of options for insoles. I tried one with a metatarsal pad recommended by some kind of in-store computer assessment program that I stood on, contemplated a variety of metal inserts, dancers' pads and foams, but finally found one named the X-1 which IMMEDIATELY restored my confidence in my feet and allowed me to go from walking gingerly, doing the Charlie Brown "sad shuffle" with head down to driving to the Sawtooths of Idaho and Glacier National Park and putting in 200 hard miles plus 15 peaks, many big. This was far from my goals, but hey, after you've faced losing everything and not hiking at all, you can take a better attitude and just be happy with every step that isn't painful. My foot never blew up and I only wrapped a half dozen times when I felt that old heat or fatigue in the ligament, so it was quite a turn around. Some of that is just rest, as I personally went 8 weeks before my foot felt mostly normal, but at least some of it is the product. They are not cheap, but if I'm buying something, I want it to work, and if it doesn't, who cares who cheap the things are? Do not save $150 by buying other metal insoles. They will be pathetically thin and do you no good. Either buy nothing or buy the best. But take my advice or leave it.
With those metal soles under me, and the regular insoles above, boots do get heavy, but as long as they are on my feet, I hardly notice. I bought a pair, though the X-1 is sold singly. But it is heavy enough that your stride would be different if you have only one metal sole in one boot. Wearing them daily, I feel fine. When I got home to rest, walking barefoot on carpet reminded me within hours I was still injured! Seriously, I was fine walking 7 or 10 miles daily and doing a peak every other day (on average), but just going to the fridge at night means laying back down I will have some tingling in that old familiar place. Hey such is life, and I can't tell yet whether it will last until I turn 30, or forever. But life is not about perfect situations, it is about making the best of the hand you are dealt. A bad toe is a pretty minor limitation when you keep it in perspective. And gout means I have to watch what I eat. We all should do that anyway.
One thing not to do with a toe injury is to ignore it, or to get macho with it. Yes many athletes and tough guys just play through injuries, but the key with doing that is location, location, location. I have had shoulder tears, elbow blow-outs, even broken ankles, and torn muscles in the quad that never made me think twice about doing anything I wanted or sticking to a workout schedule, but a toe injury is always there. You can't very well go about walking without using your toe. Though its likely you'll begin to think, don't people hike without their big toe? Like sharks bit it off or they lost it in the war or to frostbite? Maybe I could just get mine cut off. Then it couldn't be sprained anymore, or ever again. Won't I be clever? But in the end, I side with the Mixed Martial Artists from that forum I came across when my symptoms at last matched up. A toe injury dictates the terms to you. You play by its rules. You become a slave to the thing, and spend more time worrying over your feet than any fetishist in the world ever could. If I rub it with epsom salt daily...ice three times without fail...heat pad for an hour...then it has to get better doesn't it?
Prevention is the best medicine. Being aware that this injury is serious and common may make you more aware of your feet. That alone might save you. There are also products that will repair your toe alignment and undo the damage hiking, sports, dancing, and shoes do, preventing or lessening the development of bunions. Intuitively, this makes you less prone to injuries, including the turf toe, and could alleviate strikes of gout, if you are prone, though that is not a proven certainty. The last link in the products section is for a little item I've used for years. Clearly, a lack of bunions did not keep me from getting myself into a mess, but that does not mean the product is without merit. If you're a hiker, you can use this. Your shoes will fit better, you'll walk and feel better, and your feet will look better, not that most of us care a jot.
I won't drag things on just to think of a better way to close or with the belief that enough volume of words will make this a work of singular genius. A larger volume of broth is little more filling than a teaspoon full. I hope this proves helpful to some people. Or then again, I hope it does not, because I would not wish a metatarsal sprain on anyone. At least with a broken leg or arm you get a good story and no one will tell you you are not injured.