foods are purines found - Turf Toe
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Turf Toe

Turf toe gets no respect. Let's take a closer look at the causes of turf toe and see how to treat it more effectively. Turf toe is actually a form of hallux limitus. Hallux limitus is classically described as pain and progressive decrease in the range of motion of the first metatarsal phalangeal joint (MPJ). The onset of hallux limitus is due to the following:


It's not unusual for anyone to experience joint pain at any time in their life; overexerting yourself when physically active, not warming up properly before workout routines, and being overweight by even a few pounds can put undue stress on your joints and lead to discomfort or even pain.?? There is some persistent joint paint however that should be given extra consideration, as it may be a serious arthritic condition called gout.?? What is this disease, what causes it, and what can you do to fix it?


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Functional hallux limitus - biomechanical function that results in metatarsus primus elevatus and subsequent repetitive jamming of the first MPJ. Direct physical injury - injury to the articular cartilage or subchondral bone. These injuries may be due impaction injuries or hyperextension/flexion of the first MPJ.

Other conditions - synovitis, crystal deposition diseases such as gout, systemic arthritis, external physical influences such as Dupytren's contracture, etc.

About the author:
Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle
surgeon. Dr. Oster is also board certified in pedorthics. Dr.
Oster is medical director of href=http://www.myfootshop.comMyfootshop.com and is
in active practice in Granville, Ohio.

There are many causes of gout, from genetics to a previous injury of the affected area that has left it vulnerable to the disease.?? Diet is also a common factor; those who eat foods high in sodium or salt content are more prone to this condition, as sodium helps to form these uric acid crystals.?? Many who are diagnosed with this condition are counseled to change their diet immediately and cut out all processed and pre-packaged foods, as these are typically very high in sodium content.?? While some have previously felt that certain ethnic groups were predisposed to gout, it is now believed that their diet has no doubt played a much larger part in this than just genetics.?? Also, if the body's kidneys are not functioning properly, this means that the system is not dumping the uric acid the way it is supposed to be, causing it to back up into the bloodstream and form these crystals.

There are many reason that can cause a gout. The main risk factor in a gout case is the levels of uric acid that one has in his/ her body. This increased levels can be cause by many factors, and diet is one of those.


Anatomy: The great toe joint, or first metatarsal joint consists of two bones. The proximal bone is the first metatarsal and the distal is called the proximal phalanx or hallux. These two bone move against each other in an up and down motion through what we refer to as the sagital plane. Biomechanics: The motion of the great toe joint is dependant upon the plantarflexion of the first metatasal. If the first metatarsal is limitied in its' ability to plantarflex, the joint will jam resulting in funtional hallux limitus, which as we know is one of the causes of turf toe.

Allupurinol - this is most popularly known as the brand Zylprim and is prescribed to lower uric acid levels by controlling the system that creates the substance in the body. This is more helpful for preventing gout, instead of treating attacks.

If you have painful spots on any of your joints at all, you would do well to speak to your doctor immediately.?? Gout can be treated effectively with changes in your diet, medication, and other means.?? There is no reason that you need to suffer with the pain and discomfort.

Nomenclature: First MPJ - the big toe joint Metatarsus primus elevatus - a functional or structural position of the first metatarsal First metatarsal - the foot bone making up the proximal portion of the big toe joint Hallux - the great toe

When treating turf toe be sure to recognize the fact that there is no nerve innervation in articular cartilage. Pain associated with stage one turf toe (hallux limitus) is either synovial pain or bone pain. If we recognize that painful stage one turf toe (hallux limitus) may be due to bone pain, we then realize that turf toe should be treated aggressively to insure the long term viability of the joint.

But before we go any further, we need to understand that the terms turf toe and hallux limitus aren't really synonymous. The fundamental difference between the two terms is the patient population that they affect. Turf toe is a term used in athletic circles referring to any injury of the great toe joint. Consequently, discussions about turf toe will focus on the first two causes of hallux limitus mentioned above; functional hallux limitus and direct physical injury. On the other hand, when we discuss hallux limitus, we're actually referring to a broader, 'non-athletic' patient population and need to include all three causes of hallux limitus.

Gout is a disease in which there is a buildup of uric acid, formed into crystals, which get deposited in the cartilage of joints or tendons, and even surrounding tissue.?? This causes these areas of the body to become inflamed and swollen, as with other forms of arthritis.?? While gout can really occur in any joint of the body, it usually attacks the big toe first, followed by the ankle, heel, knee, wrist, elbows, and even the spine.?? It may seem even a bit laughable to think of an inflammation of the big toe as something that needs to be taken seriously, but in reality gout is a very painful disease.?? It is usually accompanied by a burning sensation, swelling, stiffness, and a warmness of the affected area.?? Typically the patient also has a low-grade fever that lasts longer than it should.?? Many who suffer from gout even in its most minor form find that any contact of the affected area, such as with an article of clothing, can be excruciating.

Why cherries seem to help the gout patient, no one seems to know and none of the big foundations are trying to find out.?? Grant money is available for drug research but not for food research.?? Cherries have been show to relieve the pain of gout sufferers.?? Cherries contain calcium phosphorus, Vitamin A, thiamin, riboflavin, niacin and Vitamin C.?? Why not give Cherries or Cherry juice as a treatment for your gout pain.?? It is certainly a more pleasant treatment without the undesirable side effect of drug therapy.

So, as you can see, medication is not the only way to go if suffering from a gout. Some people even say that drugs are not so very useful in gout cases. Because gout is a condition that has long lasting effects, other "treatments " must be used besides medication.

Gout is a form of arthritis that's characterized by sudden, severe attacks of pain, redness and tenderness in joints. The cause of gout is a high blood level of uric acid (hyperuricemia), which can accumulate in joints and lead to inflammation. Uric acid is a waste product formed from the breakdown of purines ??? substances which are found naturally in your body as well as in certain foods.

Gout caused due to Uric Acid Crystals One of main causes of gout is the formation of uric acid crystals in the joints, skin, and kidneys. Uric acid is an end product of the body's chemical processes. Those affected by gout have a higher level of uric acid in the blood than the normal, due either to formation of increased amounts or reduced amounts of acid being passed out by the kidneys in the urine. This uric acid usually remains dissolved in the blood. But when the blood becomes too full of it, the uric acid forms needle-shaped crystals in the joints which bring about attacks of gout. Diet for Gout: After the acute symptoms of gout have subsided, the patient may adopt an all-fruit diet for further three or four days. In this regime, he should have three meals a day of juicy fruits such as grapes, apples, pears, peaches, oranges and pineapples. Drink plenty of fluids. Fluids can help remove uric acid from the body. However, limit consumption of sugar-sweetened soft drinks, which have been linked to an increased risk of gout. Maintain a healthy weight. Excess weight puts more stress on your joints and increases the risk of hyperuricemia and gout.

If you are intersted in finding more information about gout you can click on this website http://www.gout-info-center.com. Also you will find there valuable information about gout symptoms and causes of gout.


Symptoms: Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step. Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

 
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Treatment of turf toe varies with the type of healthcare provider and includes the use of rest, shoe modifications, orthotics, steroid injections and surgery. The success of non-surgical care will vary with the degree of injury, the rate at which the injury is healing and how much osteoarthritis has occurred. We see varying degrees of success with orthotics that promote plantarflexion of the first ray, effectively treating metatarsus primus elevatus and peroneus longus dysfunction. Simple arch supports can make a significant difference in the symptoms of turf toe. Should our patient not respond to conservative care in a reasonable time period, we are not reluctant to suggest surgical revision to address the problem whether it be revisions of the joint defect, shortening of a long first metatarsal or structural revision of metatarsus primus elevatus. As mentioned before, the clinical appearance of dorsal lipping or visible radiographic changes are suggestive of moderately advanced osteoarthritis, a condition that is only repaired by joint revision or replacement.

Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

Probenecid - sold as Probalan or Benemid, this is usually prescribed for gouty arthritis and chronic gout. It is also helpful in preventing gout attacks rather than treating actually occurrences. The medicine helps the kidneys eliminate more uric acid out of the body.

Think of turf toe (hallux limitus) as an isolated case of osteoarthritis limited to the first MPJ. Whether the injury is acute or due to repetitive loading, the result is a load that is applied to the subchondral bone that is greater than what the bone can tolerate. As the injury progresses, a series of micro fractures will develop in the subchondral bone. The typical soft spongy character of the metaphyseal bone changes to become brittle and hard. The result is that the articular cartilage looses its' underlying support and becomes susceptible to damage. Juxtachondral eburnation, osteophytes, lipping, spurring; call them what you like, but what you see on your x-ray is the slow progressive destruction of the joint.

Certain types of foods have in their composition purine. These compounds are known to rise the levels of uric acid. In turn, uric acid is what cause a gout. So, if you stop eating such foods, or at least try to reduce the number, then you can prevent gout attacks. Here is a list of foods that are high in purine, thus leading to gout: bouillon, brains, goose, sardines, dried vegetables, shrimp, heart, liver and many others. These are just some of the foods to avoid if suffering form a gout, or if you are one of those people susceptible to a gout. Furthermore, alcohol is also known to do a lot of damage in gout cases. Try to avoid as much as possible drinking alcohol, especially beer, if you want to lower the number of gout flares. If you can avoid the purine foods and alcohol, you will surely feel a difference in the number of gout flares, as well as in the gout signs. Levels of uric acid can also be risen by sugar and fructose. So if you want to control your gout case, then try to avoid them as well.

What's the actual physical change that takes place in the joint with turf toe? As an easy analogy, consider the changes that takes place when an apple falls from a height and is damaged. The skin of the apple appears intact but the underlying pulp is damaged. In the case of turf toe (hallux limitus), think of the skin of the apple as the cartilage of the joint and the damaged pulp of the apple is the subchondral bone. Mild cases of turf toe (hallux limitus), result in little damage to the subchondral bone and will merely exhibit signs of inflammatory change within the joint. Most authors would refer to these cases as stage one turf toe (hallux limitus). More severe cases result in damage to the joint surface, the subchondral bone or both. These are the stage two and three cases of turf toe (hallux limitus) that show visible change on x-ray. As the subchondral bone becomes increasingly damaged, it will create an uneven supporting surface for the cartilage. An increase in activity results in uneven loading of the joint due to the compression injury of the subchondral bone.

Is the onset of turf toe always the same? Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step.

Cherry juice or cherries is also good for preventing gout flares. So eat at least a half pound of these fruits to better manage your gout. It does not matter what kind of cherries you eat. All cherries are beneficial in gout cases. Cherry juice is also believed to be very good in relieving some of the gout symptoms, although this has not been proven yet. So as you can see, this tiny fruit can do a world of good in your gout case. There are also some other changes that you have to make if suffering from gout. Besides the dietary modification that you should do, some lifestyle changes must be done as well.

Colbenemid - sold as Proben-C or Col-Probenecid, this medicine treats gout direcly and also lowers uric acid. This drug contains Colchicine and Probenecid.

Apple Cider Vinegar : 1 x tablespoon mixed with a table spoon of filtered water, make sure it is organic with "Mother" still in it , add honey to taste and take about an hour after a meal 3 times a day..this will regulate your pH levels and reduce them...clean your teeth also after using this as it stains..then after an attack reduce this to once a day. Medical Treatment

Unger, K., Rahimi, F., Bareither, D., Muehleman, C. The Relationship Between Articular Cartilage Degeneration and Bone Changes of the First Metatarsophalangeal Joint. J. Foot Surg. 39:1 24-33, 2000

For the long-term, you may be advised to take moderated daily doses of either NSAIDs or oral colchicine to stave off future attacks. To reduce uric acid levels, tophi formation, and sudden attacks, allopurinol or probenecid may be prescribed. Proper treatment may allow you to control gout symptoms and live normally. It will work better if you also undergo physical exercise and alter your dietary patterns to reduce uric acid levels.


Differential Diagnosis: The differential diagnosis of turf toe includes; Arthitis Fracture Gout Joint infection Joint or bone tumor Synovitis

References: Lombardi, C.M., Silhanek, A.D., Connolly, F.G., Dennis, L.N., Keslonsky, A.J. First Metatarsophalangeal Arthrodesis for Treatment of Hallux Rigidus: A Retrospective Study. J. Foot Surg. 40:3, 137-143, 2001

Ronconi, P., Monachino, P., Baleanu, P.M.,Favilli, G. Distal Oblique Osteotomy of the First Metatarsal for the Correction of Hallux Limitus and Rigidus Deformity. J. Foot Surg. 39:3, 154-160, 2000

Always consult your doctor before using this information.

This Article is nutritional in nature and is not to be construed as medical advice.


 
 
     
 
 





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