Turf Toe - Everything You Need To Know

Turf toe is a sprain of the joint at the base of the big toe. When the toe is repeatedly and forcibly bent upwards past what is considered a normal ROM in dorsiflexion, it can cause jamming of the joint around the big toe and may cause damage to the surrounding tendons and ligaments.

Your big toe has two joints. The metatarsophalangeal (MTP) joint is the largest of these. This is where the first long bone of your foot (metatarsal) connects with the first bone of your toe (phalanx). Important structures surround this joint and hold it in place. These include fibrous tissues under your MTP joint (plantar plate), ligaments located on the side of your big toe, a tendon that runs under your first metatarsal bone, and two small unattached tiny that help this tendon function.

Turf toe got its name because the injury became more common when football players began playing on artificial turf instead of grass. Artificial turf is harder and less shock-absorbent than grass. It is particularly common in professional athletes who play football or other sports on artificial turf, but it also occurs in a wide variety of sports and activities. It is relatively uncommon in people who are not athletes.

Turf toe typically happens when you have your toe planted on the ground and your heel raised. Turf toe occurs if you apply a force to your toe that makes it angle upwards more than it should. For example, it may happen if you are pushing off from a sprint and your toe gets stuck in the ground. Turf toe is a sprain to the ligaments around the big toe joint, which works primarily as a hinge to permit up and down motion.

Forcing the joint beyond the normal range of motion can also contribute to the development of turf toe.

Normal ROM in dorsiflexion of the 1st MTP joint is between 35-and 70 degrees although these numbers can vary up to 90 degrees depending on anatomical structures. Just behind the big toe joint in the ball of your foot are two pea-shaped bones embedded in the tendon that moves your big toe called sesamoids. These bones work like a pulley for the tendon and provide leverage when you walk or run. They also absorb the weight that presses on the ball of the foot. When these structures are put at a mechanical disadvantage turf toe sprains can occur.

Although turf toe is named after turf football fields, athletes in other sports can suffer from this injury. Other sports that are commonly associated with turf toe include basketball, soccer, dance, martial arts, and wrestling. Activities that involve repeatedly pushing off the ground, running or jumping are typically the cause of turf toe. The combination of upward bending and pressure from pushing off come together to cause a turf toe injury along with repeated pounding upon landing after a jump.

You are more likely to get turf toe if you do athletic activities involving surfaces with artificial turf. You also may be more likely to get turf toe if you use a soft, flexible shoe, instead of a shoe that gives more support to the front of your foot. Athletic positions that require the athlete to be in a crouched position, keeping the big toe dorsiflexed (bent upward), as in a football or rugby lineman, may be more at risk, especially if another player falls onto the foot, jamming the toe even more. Occupations such as roofing, and flooring can cause a turf toe injury as the result of kneeling that is required for the job.

To diagnose turf toe, the doctor will ask you to explain as much as you can about how you injured your foot and may ask you about your occupation, your participation in sports, the type of shoes you wear, and your history of foot problems. The doctor will then examine your foot, noting the pattern and location of any swelling and comparing the injured foot to the uninjured one. The doctor will likely ask for an X-ray to rule out any other damage or fracture. In certain circumstances, the doctor may ask for other imaging tests such as a bone scan, CT scan, or MRI. Turf toe is typically caused by a sudden trauma as opposed to an ongoing strain. Athletes who suffer from turf toe are often aware of exactly when they became injured. Symptoms begin suddenly and will typically become worse over time.

The basic treatment for treating turf toe, initially, is a combination of rest, ice, compression, and elevation (remember the acronym R.I.C.E). This basic treatment approach is designed to give the injury ample time to heal, which means the foot will need to be rested and the joint protected from further injury. The doctor may recommend an over-the-counter oral medication such as ibuprofen to control pain and reduce inflammation.

To rest the toe, the doctor may tape or strap it to the toe next to it to relieve the stress on it. Another way to protect the joint is to immobilize the foot in a cast or special walking boot that keeps it from moving. The doctor may also ask you to use crutches so that no weight is placed on the injured joint. In severe cases, an orthopedic surgeon may suggest a surgical intervention.

Using RICE treatment along with anti-inflammatory medications is usually helpful. The athlete must also rest the sore toe to allow the joint to heal.

It typically takes two to three weeks for the pain to subside. After the immobilization of the joint ends, some patients require physical therapy to re-establish range of motion, strength, and conditioning of the injured toe.

Other standard treatments are turf toe plates. Turf toe plates are generally made of fiberglass or carbon fiber although sometime spring steel is used, although not as successfully. The purpose of using stiffening plates inside of footwear is to limit the movement of the big toe, especially in dorsiflexion (upward). Carbon fiber is now being used more commonly because this material is lightweight, and its flexibility can be adjusted to the individual athlete’s needs. Carbon fiber also adds back some of the spring (propulsion) that is lost in turf toe injuries.

One goal of treatment should be to evaluate why the injury occurred and to take steps to keep it from recurring.

One way to protect against turf toe is to wear shoes with better support to help keep the toe joint from excessive bending and force with pushing off. You may also want to consider using specially designed inserts such as custom orthotics with a stiff forefoot area. Choosing footwear that is has a less flexible sole may also help.

A physical therapist or a specialist in sports medicine can also work with you on correcting any problems in your gait that can lead to injury and on developing training techniques to help reduce the chance of injury.

How long Does it Take for Turf Toe to heal? What are possible complications of turf toe? Turf toe may cause long-term stiffness and pain in your joint. Do all your physical therapy exercises as prescribed. They can help decrease stiffness and pain.

If you are an athlete, check with your healthcare provider and trainers to see when you might be ready to return to your sport. But these are general guidelines for return to play:

Grade 1 – (Mild Strain) May be able to return to play very soon after the injury: maybe a week.

Grade 2 – (Sprain) Possible return to play in 2-3 weeks.

Grade 3 – (Total Capsule Rupture) 2-3 months. Full recovery may take up to a year or longer.

Although sometimes turf toe is regarded as just a part of athletics, if left untreated it can end an athletic career.

Untreated, chronic turf toe can result in osteoarthritis of the big toe joint, which may result in;

• Hallux (Abducto) Valgus (Bunions), is a deformation of the 1st MTP wherein the big to abducts toward the second toe.
• Hallux Limitus – Limitation of the ROM in dorsiflexion of the big toe.

Hallux Rigidus – Complete fusion of the 1st MTP