Turf Toe

Sports fans don’t ever want to hear the term “turf toe” when it comes to their favorite athlete or the star player on their team. But few people actually know what the condition involves. What they do generally know is that this sports injury can sideline athletes from competition for quite some time.

We treat many patients for various sports injuries, (including turf toe) at our Upperline Health clinics, so let’s take a closer look at this injury and learn how you can end up with this “big toe pain.”

What is Turf Toe?

To start with, it can help to understand the anatomy of the big toe. Basically, your big toe has two joints, with the larger one being the metatarsophalangeal (MTP) joint. This is the joint where the metatarsal (long bone in the foot) meets the first phalanx (toe bone). When you have turf toe, the injury takes place in the MTP joint.

This joint is surrounded by the plantar complex, which is a series of important structures, including the plantar plate, collateral ligaments, flexor halluces brevis (tendon providing strength and stability for the big toe), and sesamoids (two small bones found in the flexor tendon). This complex is affected during a turf toe injury.

Turf toe is essentially a sprain in the MTP joint of the big toe. The injury occurs when the toe is hyperextended (forcibly bent upwards). This can be the case when pushing off the ground during a sprint or if the front foot is planted in the ground when the rest of the foot comes over the top. Medical professionals started seeing this injury more frequently as artificial turf became more common, therefore the name “turf toe.” The reason for the increased occurrences with artificial turf (versus natural grass) is simply because artificial turf is a harder surface and doesn’t “give” as much when forces are placed upon it.

Symptoms of Turf Toe

Symptoms of turf toe do vary based on the severity of the injury. This is seen in the three grades:

• Grade 1 – Slight swelling and pinpoint tenderness due to stretching of the plantar complex.
• Grade 2 – Moderate swelling, widespread tenderness, and bruising due to partial tearing of the plantar complex. You will find movement of your toe to be painful and limited.
• Grade 3 – Severe swelling, tenderness, and bruising. The plantar complex is completely torn, which leads to considerable pain and difficulty in moving the toe.

Treatment for Turf Toe and Big Toe Pain

When the injury is first sustained, your best course of action is to use the RICE protocol. This means to rest, ice, compress, and elevate the affected foot. Start by taking time away from the activity that lead to the injury and avoid placing weight on the foot (including walking) as much as possible. Ice the MTP joint several times a day, for 20 minutes at a time. Wear an elastic compression bandage on your foot and elevate your leg to reduce and prevent additional swelling.

For a Grade 1 sprain, the RICE protocol, combined with taping and medication, will be at the center of our treatment plan. We may also prescribe orthotics to reduce stress on the plantar complex. Grade 2 sprains might require the use of a walking boot, along with the Grade 1 treatment protocols. In the case of a Grade 3 sprain, the area will need to be immobilized for several weeks. A walking boot or cast will keep the big toe in the proper position for optimal healing.

Physical therapy can play a key role in preventing and reducing stiffness, along with strengthening and stretching the injured toe. Surgery is not usually needed, but it can be a possibility in some cases. If we recommend this for you, we will discuss it with you so that you understand this treatment procedure.