Bulls’ Derrick Rose Re-Injures Turf Toe, Dr. Silverman Comments
Chicago Bulls’ all-star guard, and reigning league MVP, Derrick Rose, re-aggravated his turf toe (another name for a sprain of the big toe) during last Tuesday’s game against the Minnesota Timberwolves.
After the game, Rose told reporters: “I can’t bend my big toe at all. But towards the end, I didn’t feel it. They just wrapped it up, I took an Advil. I was good.”
Rose has been out since that game, trying to rest and recover.
Dr. Silverman Comments
Turf toe is a sprain of the large knuckle on the big toe joint. The injury occurs when you jam your big toe into the ground and it bends up towards your ankle too far. The severity of the injury varies from sprains to joint dislocation. Acute turf toe is a difficult injury to treat and requires enforced rest and, in the most severe cases, surgical reconstruction.
Rose doesn’t have an acute turf toe injury. He has arthritis of his left great toe joint (aka Hallux Rigidus). This problem has several other aliases:
- Stiff Big Toe
- Hallux Limitus
- Dorsal Bunion
Arthritis of the great toe joint can come about from a turf toe injury, dropping an object on the foot, badly stubbing the toe, or just plain bad luck.
Hallux Rigidus has several grades, outlined in the table below.
|Grade||Loss of Range of Motion||X-ray Findings||Symptoms|
|0||<20%||Normal radiographic results||Mild, no pain|
|1||20-45%||Dorsal spurs||Pain with activity|
|2||50-75%||Mild flattening of big toe joint, joint narrowing, or bone spurs||Moderate pain|
|3||90%||Severe radiographic changes with huge cysts||Constant moderate to severe pain|
|4||Stiff Joint||Loose pieces of bone or large bone cysts||Severe pain|
Rose likely has Stage II Hallux Rigidus. This is the same problem that plagued Shaquille O’Neal throughout his career.
- Option I: Do nothing and live with it.
- Option II: Non-surgical treatment with a rigid insert in the shoe that blocks the bending of the great toe joint. In athletes and most people that walk, this doesn’t routinely relieve the problem and it limits shoewear choices. Injections are only temporary and great for a big event like a wedding or a hiking trip, but they can’t be repeated too often. Derrick Rose is working with Option II right now and that is reasonable, but he will continue to have these setbacks.
- Option III: Surgery to fix the problem. Surgery for Grade 1 and 2 injuries includes removing spurs. For Grades 3 and 4, more needs to be done as the problem will likely recur. Many doctors simply try to apply the spur excision surgery to Grades 3 and 4. This works in the short run but in less than 5 years the problem will likely return. Most Surgeons will simply fuse the big toe. This works well to alleviate pain but, it ends an athletic career and destroys an entire closet full of high heel shoes.
I perform a procedure known as a Soft Tissue Arthroplasty. I remove the arthritis and replace the cartilage using the body’s own tissue. Results are incredible and athletes return to playing sports. Very few doctors perform this procedure as fusion is the “Gold Standard.” But, as I always say, you can always do a fusion but, you can’t undo a fusion. Since I began doing this procedure in 2005, I have only had to take one patient back to the operating room to perform a fusion after she fell and broke the toe one year after a successful replacement surgery.
Derrick Rose is in for a tough time. This problem will irritate him and limit his desire to push off of that left foot. He will limit his moves to push off more often from his right foot. He will land on the right side alone or on the outside of his left foot (risking ankle sprains). He will slowly lose some of his speed and become more predictable to defenders.