While “turf toe” brings to mind an image of a college or professional athlete playing on artificial turf, it’s a fairly common injury that can affect a wide range of patients – athletes and non-athletes alike. It can be causes by a wide variety of hard surfaces, as well, including basketball courts, natural grass fields and hard floors.
Turf toe is simply a sprain in the ligaments of the big toe joint, which enables the toe to move up and down like a hinge. Jamming the toe, or repeated forces like running or jumping may cause this injury. Bending the big toe back too far toward your foot may also cause this injury.
Early symptoms of turf toe include pain – both acute (immediate, resulting from force or trauma), or chronic (gradually worsening over time), tenderness in the big toe and nearby joint, swelling and stiffness.
In addition to competitive athletes, other active individuals such as ballet dancers, cheerleaders or those who exercise on hard surfaces, may experience turf toe.
Your foot and ankle doctor at Campbell Clinic will conduct a visual exam and may also order X-rays. Generally, rest, ice and elevation will help a patient recover from turf toe. Without proper rest from sport and exercise, the symptoms associated with turf toe may worsen over time. Compliance with recovery is critical to avoid reaggrivation of the injury.
Do you feel or have any of these symptoms?
Those with turf toe often experience
- Swelling
- Bruising, pain
- Tenderness
- Limited joint movement
- Difficulty applying weight to the big toe
What is turf toe?
The simplest definition of turf toe is that it is a sprain of the main joint of the big toe. The injury happens when the toe is forcibly bent up into hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground.
Although often associated with American football, turf toe occurs in a wide range of sports and activities.
Usually the injury occurs with a very sudden and forceful extension of the toe.
To help plan treatment for turf toe, doctors grade the injuries from 1 to 3 — mild to severe.
- Grade 1 – The plantar complex has been stretched, causing pinpoint tenderness and slight swelling.
- Grade 2 – A partial tearing of the plantar complex causes more widespread tenderness, moderate swelling, and bruising. Movement of the toe is limited and painful.
- Grade 3 – The plantar complex is completely torn, causing severe tenderness, severe swelling, and bruising. It is difficult and painful to move the big toe.
Risk factors:
- You have high-arched feet or flat feet.
- You wear shoes that don’t support your feet (especially for a long time on a hard surface).
- You’re obese. (70% of patients with plantar fasciitis are also obese.)
- You’re an athlete.
- You’re a runner or jumper
- You exercise without stretching your calves.
Reasons to see a physician and treatment options
While turf toe injuries are often mild, you should make an appointment with a foot and ankle orthopedic surgeon if it is too painful to walk on the affected foot, if there is a lot of swelling and bruising, or if physical activities, such as running and playing sports, become difficult.
Surgical treatment
Surgery is often not necessary for treating turf toe. However, if your symptoms persist or your level of athletic play is affected, surgery may be an option. Doctors most often recommend surgery for larger Grade 3 injuries, such as:
- A severe tear of the plantar complex
- Fracture of the sesamoid
- Vertical instability (unusual up and down motion) of the MTP joint
- Loose bony chip in the joint
- Damage to the cartilage of the joint
- New or worsening bunion (turning outward of the big toe)
The surgical procedure will vary according to the injury. The aim of surgery is to repair the soft tissues and restore the MTP joint motion to preserve normal function.
Prevention methods and other tips
- Avoiding playing sports on artificial surfaces- Artificial surfaces tend to be harder and less shock absorbent than grass and do not give as much when forces are applied to them.
- Wear shoes designed specifically for artificial surfaces-athletic shoes designed for artificial surfaces are softer and more flexible, providing the athlete with more agility, but much less stability in the forefoot.
Anatomy
The big toe is made up of two joints. The largest of the two is the metatarsophalangeal joint (MTP), where the first long bone of the foot (metatarsal) meets the first bone of the toe (phalanx). In turf toe, the MTP joint is injured.
The MTP joint is the large joint closest to the base of the big toe.
Several structures work together to protect and stabilize the MTP joint.
The MTP joint is surrounded by important structures that hold it in place and prevent it from dislocating. Together these structures are referred to as the plantar complex.
Recovery and return to activity
- Grade 1. Pain is usually tolerable and an athlete can continue sports participation using a stiff-soled shoe. Orthotics, such as a thin, graphite shoe insert with a rigid forefoot component, can reduce stress on the plantar plate and provide stability.
- Grade 2. In most cases, an athlete with a Grade 2 injury needs 3 to 14 days of rest before returning to play
- Grade 3.Physical therapy may be helpful and should begin as soon as symptoms allow. Specific exercises will help to stretch and strengthen the big toe. Early joint movement is essential for reducing or preventing joint stiffness.
Turf toe injuries that are addressed early typically heal fairly well.
A wide range of mild to moderate, but persistent symptoms — such as pain and joint stiffness — are the most common complications.
