Swollen Uvula – Causes, Symptoms, Treatment and Home Remedies

What is Uvula?

Uvula is a bell shaped tissue that appears like a dangling grape like structure at the back of the throat.

 Picture 1: Uvula.  
Image Source: google.com image

It is made up of connective tissue, muscle fiber, and a number of glands.

Researchers are still baffled about the exact function of the uvula. [1] They have attributed various functions to uvula –
  • Uvula helps in preventing the food from going into the nose while swallowing by effectively sealing off the opening between the nasal cavity and the pharynx.
  • Uvula is believed to be an accessory organ of speech. It influences the tone of the voice, that is, it is required to bring out the guttural sound of a few consonants, for example, K or G in languages such as French, Arabic, or German where the palate and the uvula work together to produce what is called the ‘uvular consonants’.
  • However, the most important function attributed to the uvula so far is its ability to produce copious thin and watery saliva. A literature review by Gary Back and his colleagues at York District Hospital, York, revealed that a common complication of uvulectomy (surgical removal of the uvula) is dryness of the throat. The researchers thus proposed the theory that the uvula bastes the throat and thereby helps keep it moist and well lubricated. [2]

Causes of Enlarged or Swollen uvula

Enlarged uvula or swollen uvula is medically termed uvulitis. In most cases when the uvula swells the surrounding structures such as the epiglottis and tonsils are also affected. Many people with swollen uvula may feel that their uvula is touching their tongue or sticking to the tonsils. Sore throat because of swollen uvula is of common occurrence. 
The swollen uvula can be pale and translucent in which case it is termed uvular hydrops. [3] It is usually a self-limiting idiopathic condition that may cause (but rarely) acute airway obstruction. 

The swollen uvula can also be red or skin colored accompanied by pain and tenderness. This is called angioedema. 

Although swollen uvula is more common in middle-aged men, in over 50 percent of cases there is no known cause of the condition. [6] However, in general, the following conditions can cause swollen uvula.

  • Infection: Infections can be viral or bacterial including group A streptococci, Haemophilus influenzae, and Streptococcus pneumoniae. [3] Strep throat, a contagious disease caused by streptococcal bacteria, is a common cause of swollen uvula. Uvula can enlarge because of tonsillitis or epiglottitis as well. The known infectious causes of uvulitis.
  • Allergic reactions: Allergic reactions in the throat and mouth can spread to the uvula and cause it to swell. This however may be a sign of food induced anaphylaxis especially if accompanied by difficulty in breathing or wheezing (dyspnea, bronchospasm, stridor), and sudden drop in blood pressure. [4] This condition requires immediate medical attention.
  • Quincke’s disease: It is also known as angioedema or angioneurotic edema. Angioedema is of four types –  
  1. Acute allergic occurring almost always with hives
  2. Non-allergic drug reaction which is ACE inhibitor induced
  3. Idiopathic in which case the cause is yet unknown
  4. Hereditary and recurring periodically
  • Snoring. [6]
  • Physical trauma to the throat or mouth, for example, during an endoscopy or after intubation. Sometimes, tonsillectomy too can cause swollen uvula.
  • Thyroid problems. [5]
  • Smoking, drug abuse, excessive alcohol consumption.
  • Prescription drugs and opioids. For example, a case study from Albert Einstein Medical Center, Philadelphia, revealed that a patient developed opioid induced uvular hydrops when she was given morphine after a Caesarean delivery. The doctors found it to be an inflammatory response caused by opioid-induced direct degranulation of mast cells and basophils. [5]

Symptoms of Swollen Uvula

  • Difficulty in swallowing or drinking
  • Gagging
  • Sore, dry, throat
  • Fever, headache
  • Uvula touching the tongue
  • White spots or patch on the uvula   
  • Inflamed tonsils
  • Cold and cough
  • Hoarseness, difficulty speaking

Treatment of swollen uvula

  • Antihistamines: Hydroxazine 50-100mg im or diphenhydramine 25-50mg iv along with cimetidine 300mg iv or orally, or ranitidine 50mg iv or 150mg orally. [3]
  • In severe cases, repeated doses of epinephrine are given. Nebulized isomeric or racemic epinephrine or albuterol are also effective.[3]
  • Corticosteroids such as SoluMedrol 125mg iv are also typically used, although efficacy is not yet proven. [3]
  • Treatment for angioedema includes intravenous methylprednisolone, diphenhydramine, and intramuscular epinephrine. Patients who do not respond to these medication may have a complement deficiency and should also receive plasminogen inhibitor ε-aminocaproic acid. [7]
  • Surgical removal of uvula in cases of obstructive sleep apnea or to prevent sudden infant death syndrome (SIDS).

Home Remedies for swollen uvula

  • Taking OTC medication for pain is the first line of treatment for the pain associated with the swelling of uvula.
  • Gargling with salt water helps reduce the swelling.
  • Drinking warm beverage with added honey.
  • If the swollen uvula is not due to cold or cough, consuming iced tea, ice cream, or cold drinks may alleviate the swelling.
  • Stop drinking till the swelling subsides, if the swollen uvula is the result of excessive drinking or being allergic to alcohol.

Swollen uvula is not a fatal condition and one can recover pretty quickly with home remedies and basic treatment for the swelling.

  1. Adoga AA, Nimkur TL. The Traditionally Amputated Uvula amongst Nigerians: Still an Ongoing Practice. ISRN Otolaryngology. 2011;2011:704924.
  2. Back GW, Nadig S, Uppal S, Coatesworth AP. Why do we have a uvula?: literature review and a new theory. Clinical Otolaryngology and Allied Sciences. 2004;29(6):689–693.
  3. National Center For Emergency Medicine Informatics. 'Quincke's Disease. Uvular edema'. http://www.ncemi.org/cse/cse0412.htm 
  4. Cianferoni A, Muraro A. Food-Induced Anaphylaxis. Immunology and allergy clinics of North America. 2012;32(1):165-195.
  5. Pande SA, Raghav K, Mehta S, Babbar G, Kandpal S. 'A Woman With A Swollen Uvula'. Cleveland Clinic Journal of Medicine. 2012 Sep;79(9):600-1.
  6. Alcoceba, E. Edema Of The Uvula: Etiology, Risk Factors, Diagnosis, And Treatment. Journal of Investigational Allergology and Clinical Immunology. 2010; Vol. 20(1): 80-83
  7. Johnson, Warren, Nirav Shastri, and Milton Fowler. 'Quincke's Disease - The Western Journal Of Emergency Medicine'. The Western Journal of Emergency Medicine. N.p., 2011.

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Upper Lip Twitching - Causes and Treatment

Lips are the structure which covers the opening of the mouth and consists of the upper and the lower lips. Each of the lip is surrounded by the orbicularis oris muscle which encircles its opening.[1]

Lip twitching is the sudden abnormal involuntary contractions of the lip muscles. It may sometimes involve the upper, lower or both the lips together. It might be due to some direct stimulation or due to irritation of the nerve supplying the muscles surrounding the lips.

Different people may experience different symptoms of lip twitching. But usually it is felt as slight tremors of only the upper lip or of the entire side of the face. Along with this, few might have numbness or some abnormal sensation of that part of the lip or curling sensation of the edges of the lips.[2]

Upper Lip Twitching Superstition 

Upper lip twitching or lip twitching in general is associated with many superstitious beliefs. It is believed that if your upper lip is twitching, you are going to kiss someone or you are going to hear some good news; however if your lower lip is twitching, you will be kissed by someone or going to receive some bad news.

Similarly, if the right side of your lip twitches, something good is going to happen that day or if your left side of the lip twitches, something bad is going to happen that day.[3,4]

There are multiple causes for upper lip twitching. Some of the commonest causes are:
  • Severe anxiety or stress
  • Excessive fatigue
  • Excess caffeine
  • Nicotine (cigarette) abuse or withdrawal
  • Alcohol abuse or withdrawal
  • Other substance withdrawal – cocaine, heroin, amphetamines
  • Electrolyte imbalance – mainly hypokalemia (reduction of potassium in blood, seen with other symptoms like muscle weakness, muscle cramps, constipation etc)
  • Herpes simplex infection of the lips (cold sore / fever blisters)
Other causes for persistent twitching are:

Bell’s palsy 

a condition with temporary weakness or paralysis of the muscles of one side of the face due to damage or trauma to the nerve supplying the facial muscles (facial nerve) [5,6]. The other symptoms include lack of sensations on that side of the face, drooling of saliva, inability to close the eye on the affected side which leads to dry eye, loss of taste, increased sensitivity to hearing on the affected side etc.


 is a condition where low level of parathyroid hormone is secreted in the body which leads to low blood and bone calcium levels. Along with lip twitching, the other symptoms are muscle weakness and cramps, tingling and burning sensation of limbs and  psychiatric symptoms (depression, memory disturbances etc) [7].

Parkinson’s disease 

Is a progressive disease of the nervous system which mainly affects the movement [8,9]. The main symptoms here are muscle rigidity, changes in gait and speech, tremors (could include muscle twitching), mood and behavioral changes, postural instability etc.

Tourette’s syndrome 

Is a genetic neurological disease where children are seen to have abnormal involuntary movements and noises which are known as tics [10]. The tics could be motor tics (sudden brief repetitive movements involving any muscle groups) or vocal tics (repetitive throat clearing, grunting or sniffing) [11].

These tics worsen during stress or anxiety. Tourette’s syndrome is usually associated with ADHD (Attention Deficit Hyperactivity Disorder) or OCD (Obsessive Compulsive disorder, where a person keeps doing same work repetitively).

Amyotrophic Lateral Sclerosis 

is a type of rapidly progressing neurological disease which occurs due to the death of the motor neurons in the brain (including the brain stem) and the spinal cord. This leads to gradual muscle weakening resulting in speech slurring, muscle twitching and weakness of any limb, followed by progressive respiratory muscle weakening  finally leading to death. [12,13]

Upper Lip Twitching - Treatment

Many a times, lip twitching is self-limiting; i.e. it gets controlled on its own without any treatment. Controlling the underlying causes such as anxiety, substance abuse or withdrawal (including nicotine, alcohol, caffeine etc), consuming a well-balanced diet also helps. Meditation, relaxation techniques help when it is due to severe stress or anxiety. For immediate relief, applying pressure with finger to the twitching area or applying a warm cloth to the area stops the twitching immediately.

However if inspite of all this if the twitching persists or increases in severity or frequency, the doctor should be consulted immediately to rule out any other underlying causes. [2,4,14]

  1. http://www.britannica.com/science/lips
  2. healthool.com/lip-twitching
  3. http://www.dailynews.gov.bw/news-details
  4. http://www.etopical.com/upper-lip-twitching-causes-meaning-superstition-left-right-lip-twitching-symptom
  5. http://www.webmd.com/brain/tc/bells-palsy-topic-overview
  6. http://www.ninds.nih.gov/disorders/bells/detail_bells.htm
  7. http://www.mayoclinic.org/diseases-conditions/hypoparathyroidism
  8. http://www.mayoclinic.org/diseases-conditions/parkinsons-disease
  9. https://en.wikipedia.org/wiki/Parkinson%27s_disease
  10. http://www.nhs.uk/Conditions/Tourette-syndrome
  11. http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm
  12. (http://www.mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis
  13. http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis
  14. http://www.newhealthguide.org/Lip-Twitching.html

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Pain in the Right Side of the Chest - Causes and Treatment

Chest pain is one of the most common symptoms reported in the hospital. More often than not, laypersons think that chest pains are the manifestion of heart and lung diseases. This is not entirely true especially if the pain is on the right side of the chest. After all, heart and lungs are not the only organs found inside the chest.

Chest pain is associated with a lot of diagnoses. Some of them may be simple diagnoses that require no or little treatment. Some of them may be critical that could lead to death if not medically unattended. 

Chest ache should never be neglected even if you keep on coming back to the hospital because of it. Better be sure than sorry because your life is on the line.



Heart Problems - Causes and Solution

Myocardial Infarction (MI)

MI, more commonly known as heart attack, is a medical emergency which occurs when there is an occlusion in the blood vessels that supply the heart. The myocardium (heart muscle) is being deprived of blood and oxygen that it needs in order to function and survive. This causes the severe crashing chest pain. Area/s of the heart become ischemic and myocardial cells may die if not immediately treated. 

In MI, the left side of the chest is almost always reported as painful. However, it is still important to consider the slightest chance that pain on the right side of the chest may be due to MI.

Also see : Massive heart attack 


Lung Problems - Causes and Solution

Pulmonary Hypertension

This refers to an increased pressure within the blood vessels of the lungs. The stabbing pain on the right chest is like that of the angina.



When the lung is injured, it releases air within the chest cavity. This is a condition called pneumothorax. This causes chest pain that is exacerbated by breathing and is accompanied by hypotension. It is literally painful to breathe when the patient suffers from this. Measures are performed in order to release the air that is trapped inside the chest cavity and to prevent further damage to the lungs.


Pulmonary Embolism

This is a blood clot that travelled from a different part of the body to the lungs. This causes the patient to have right sided chest pain, difficulty of breathing, tachycardia, fever, acute pleuritis, shock, or even death. 

Pleuritis or Pleurisy

Pleuritis or pleurisy is the inflammation of pleura or the lining that surrounds the lung. The lungs expand and partially deflate as you breathe. That goes with the pleurae since they cover and protect the lungs. If these are inflamed, the person will feel sharp stabbing chest pain especially during deep breathing, coughing, or sneezing.

Causes of pleuritis or pleurisy include pneumonia, pneumothorax, pulmonary embolism, lupus, rheumatoid arthritis, and cancer. 

If the cause is bacterial in nature, antibiotics will be prescribed by the doctor. If the cause is viral, the patient will be given symptomatic treatment since virus goes away on its own in due time. If the cause is something else, treat it in order to get rid of the pain on the right side of the chest.


Musculoskeletal Problems


Rib Subluxation and Fracture

Rib subluxation or displacement is a common cause of right sided chest pain, especially on the upper portion of the chest. Bending forward exacerbates the pain but it goes away within 1-2 weeks.

Rib fracture is worse because the pain is felt just by breathing or coughing. 

Right sided chest pain due to rib subluxation and fracture may be relieved by warm compress, bandaging, and analgesics.
 For further information see : Pain under Right Rib Cage



Costochondritis is the inflammation between the costal cartilage and ribs by rubbing against each other. Though not a serious condition, costochondritis is painful. The pain over the right side of the chest is diffused and not only concentrated on a certain area. A simple warm compress relieves the pain.


Gastrointestinal Causes and Treatment

Gastroesophageal Reflux Disease (GERD)

GERD is also known as heartburn, acid reflux, or indigestion. This is a condition wherein acidic contents of the stomach go up to the esophagus, leaving your mouth with a sour taste. 

This is manifested as right sided chest pain with burning sensation because of the proximity of the esophagus to the heart, hence its name heartburn. The esophagus and heart also have the same nerve network. 

GERD occurs after overeating, lying down immediately after a meal, and eating fatty or spicy foods. It can also be triggered by alcohol, cigarette smoking, and stress. Obese and pregnant women are particular at risk. 

Treatment of GERD is primarily avoidance of foods and drinks that may trigger it such as fatty and spicy foods, coffee, tea, and alcohol. It is also important to stay upright a few hours after eating. Avoid cigarette smoking and stress. Follow a healthy lifestyle. 


Cholelithiasis and Cholecystitis

The term “chole” refers to the gallbladder. “Lith” refers to stone and the suffix “-itis” refers to inflammation. 

Essentially, cholelithiasis or gallstones develop first before cholecystitis because it is the gallstones that block the passageway of bile from the gallbladder. Since there is a blockage, gallbladder becomes irritated and inflamed. Fat women in their 40s are usually at risk.

The gallbladder is located beneath the liver on the right upper quadrant of the abdomen. As a result, problems with the gallbladder manifest as pain over the right upper quadrant of the abdomen and right lower part of the chest. 

Cholesterol and bile crystallize to form gallstones, that is why abdominal and chest pains intensify as the person eats fatty foods.

Cholelithiasis and cholecystitis should not be left untreated. Medications that dissolve the gallstones will be prescribed by the doctor. If severe enough, it warrants the need for cholecystectomy or removal of the gallbladder.

Peptic Ulcer Disease (PUD)

PUD refers to the presence of painful sores along the gastric or intestinal mucosa. As a result, the patient experiences recurrent abdominal and chest pain on the right side. PUD is caused by excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, and cigarettes. Antacids provide relief by increasing the gastric pH or making it less acidic.


Problems of the Pancreas and Liver


Pancreatitis refers to the inflammation of the pancreas. This occurs when pancreatic enzymes get activated before being secreted into the small intestines, making these enzymes “eat up” the pancreas. This leads to inflammation of the pancreas and swelling of a portion of the abdomen. Severe pain is felt on the abdomen and right side of the chest. This is exacerbated by lying down and relieved by leaning forward.



Caused by a hepatitis virus, patients suffering from this condition commonly experience “popping” of the right side of the chest, ribs, shoulder, and back. The liver is located in the right upper quadrant, that is why the right side of the body suffers more than the left.
Other Factor Contributing to Right Sided Chest Pain

Viral Infection

Viruses that cause shingles, hepatitis, influenza, rhinitis, etc. may make the hosts suffer by letting them experience sharp stabbing pain over the right side of the chest that radiates to the shoulders, arms, neck, and jaws. Antivirals are prescribed to get rid of the virus.

  1. http://www.newhealthguide.org/Pain-In-Right-Side-Of-Chest.html
  2. http://www.buzzle.com/articles/chest-pain-right-side-chest-pain.html
  3. http://www.md-health.com/Pain-In-Right-Side-Of-Chest.html
  4. http://www.livestrong.com/article/25312-right-side-chest-hurt/
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Turf Toe - Symptoms, Pictures and Treatment (Recovery)

What is Turf Toe?

It was in 1976 when “turf toe” was used by Bowen and Martin to describe a common sports injury that refers to “sprain of the plantar capsuloligamentous complex of the metatarsophalangeal joint of the great toe [1, 2].” Famous American football players like Deion Sanders and Tom Brady are among the many who have already experienced this injury.

Picture 1: Turf toe refers to sprain of the plantar capsule ligamentous complex of the metatarsophalangeal joint of the great toe.
Image Source: kenoshaorthopedics.com

Causative Factors of Turf Toe

 Almost all victims of turf toe injury are athletes who engage in contact sports, specifically football (most common), wrestling, lacrosse, and rugby.
The reason why this injury is called “turf toe” is because the culprit is pointed to artificial turf plus the use of flexible shoes.

Picture 2: Flexible shoes causes turf toe.
Image Source: orthoinfo.aaos.org

According to a study, more cases of turf toe injury happen in modern artificial turfs than in natural grass fields. It was also reported that 45% of National Football League (NFL) players have already suffered from turf toe injury and most of them happened in artificial turfs.

Turf toe injuries may also be caused by dancing, running, basketball, horseback riding, and even in vehicular accidents. Other contributory factors include the person’s age, weight, position, great toe motion, flat metatarsal head, ankle dorsiflexion, and previous injury to the area.

There are medical conditions that can cause turf toe. These are gout, arthritis, sesamoiditis, bunion, hammer toe, fracture, blister, and neuroma [1, 3, 4].

Mechanisms of Turf Toe

The mechanism of turf toe injury lies on the amount of force placed on the first metatarsophalangeal joint and the degree of movement at the time of force.

Turf toe primarily occurs due to exaggerated hyperextension of the great toe. Furthermore, the body weight of the player or another player (i.e., in football or rugby) puts axial load or vertical force on the already injured toe, worsening it.

The plantar capsule serves as a restriction for hyperextension of the metatarsophalangeal joint. In turf toe, the plantar soft tissues are torn because of excessive hyperextension. Flexible shoes are not hard enough to restrain the extension of the great toe [1, 5].

Picture 3: Hyperdorsiflexion of the Great Toe
Image Source: texasfootdoctor.org

Picture 4: Axial load worsens turf toe injury.
Image Source: angelopodiatry.com


Classifications of Turf Toe: Manifestations and Treatment (Recovery)

Signs and symptoms of turf toe include pain, swelling, warmth, discoloration, and restricted mobility and functionality of the big toe which are seen immediately after the injury [6].
Clanton classified turf toe based the severity of the injured great toe and its supporting structures. How to treat turf toe depends on the actual case of the patient and how fast it heals depends on how he complies with the treatment.

Picture 5: Capsuloligamentous Complex of the First Metatarsophalangeal Joint
Image Source: uwbadgers.com

Grade I turf toe injuries are the mildest, with limited swelling. These result from stretching of the capsuloligamentous complex of the first metatarsophalangeal joint. Range of motion of the great toe is generally unaffected because the plantar capsule is not torn.

Treatment is symptomatic which basically involves RICE (rest, ice, compression, elevation). The person is allowed to get back in the game as soon as the turf toe is healed. Taping immobilizes the first metatarsophalangeal joint, preventing further injury.

 The examiner can test the patient’s tolerance by extending the great toe at 90°. Continuous movement is tolerated if passive extension is painless.

Picture 6: Turf Toe Taping Technique
  • Use nonstretch zinc oxide tape. 
  • Place the tape around the big toe. 
  • Tape another around the middle part of the foot. 
  • Apply another set of overlapping tapes connecting the ones placed over the big toe and the middle part of the affected foot. 
  • Secure the tapes by taping the big toe and middle part of the foot once again.
Source: http://app.isai.co.uk/app_helper/app_web_mobile/23/Custom_82024.html

Grade II turf toe injuries has increased pain because there is already partial tearing of the capsuloligamentous structures. Along with this, there is moderate swelling and limitation of movement. Patient becomes limp on affected side so there may be a need for turf toe braces, walking boots, or crutches.

Pain medications and physical therapy will be helpful. Two weeks of recovery time is recommended for patients belonging to this category. As the patient returns to play, orthotic with Morton’s extension or a turf toe plate is used shoe inserts to provide rigidity and to resist torque as it allows for comfortable play. This prevents re-injury.

Picture 7: Turf Toe Brace Splinting
Image Source: amazon.com

Picture 8: Boot for immobilization of turf toe
Image Source: fieldgulls.com

Picture 9: Custom Orthotic Morton’s Extension
Image Source: columbusfoot.com

Picture 10: Turf Toe Plates used as Shoe Inserts
Image Source: myfootshop.com

Grade III turf toe injuries are the worst because there is complete tear of the capsuloligamentous structures. As a result, there is increased pain, ecchymosis, and limitation of movement (i.e., weakness upon bending the great toe and unstable metatarsophalangeal joint). At this point, the patient cannot bear weight. If turf toe is accompanied by dislocation, there may be a need for closed reduction.

This is followed by the use of immobilization devices (braces, boots, casts, and crutches), cold compress, and pain medications for 4-6 weeks. Another 4-6 weeks will be allotted for physical therapy and rehabilitation. The recovery time can take up to 10-16 weeks. He must be able to dorsiflex the great toe without pain in order for him to get back in the game.

Steroids should not be used during rehabilitation because it interferes with healing of the soft tissues and it conceals the pain which is an indicator if the patient is ready to play again. If all of these do not render improvement, surgical repair of the involved anatomical structures may be necessary [1-10].

Complications of Turf Toe

Persistent pain and joint stiffness of the big toe is the most common sequelae of turf toe injuries if left untreated.

Turf toe injuries lead to avulsion (tearing) of the plantar plate. This may result to subluxation (partial dislocation) of the sesamoid bones. Complete dislocation of the first metatarsophalangeal joint rarely happens. If the injury is severe and surgery is not performed, this may result to degenerative joint diseases such as arthritis.

Long-term complications of turf toe injuries include hallux rigidus, hallux valgus, hallux varus, arthrofibrosis, cock-up deformity, loose joint bodies, and loss of strength for push-off. Half of the patients suffer for more than 5 years. Eventually these athletes will have an early retirement due to functional disability [1, 3, 8].


  1. Philbin TM, Sports Injuries of the Foot: Evolving Diagnosis and Treatment, Springer Science & Business Media, 21 Mar 2014
  2. Saxena A, International Advances in Foot and Ankle Surgery, Springer Science & Business Media, 28 Sep 2011
  3. Thordarson DB, Foot and Ankle, Lippincott Williams & Wilkins, 2004
  4. http://www.medicinenet.com/turf_toe_symptoms_causes_and_treatments/article.htm
  5. Micheo W, Musculoskeletal, Sports, and Occupational Medicine, Demos Medical Publishing, 2010
  6. http://www.webmd.com/fitness-exercise/turf-toe-symptoms-causes-and-treatments?page=2
  7. http://orthoinfo.aaos.org/topic.cfm?topic=A00645
  8. http://emedicine.medscape.com/article/1236962-treatment#a17
  9. http://www.podiatrytoday.com/article/9063
  10. http://www.webmd.boots.com/fitness-exercise/guide/turf-toe
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