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Orthopaedic Specialties

Turf Toe

Turf toe is a sprain of the biggest joint in the big toe. Turf toe arises when someone sprains or tears the ligaments around the big toe joint. Turf toe frequently happens to football players who play on artificial turf, but it also affects other types of athletes, including basketball, track and field, even dance and gymnastics. This hyperextension of the big toe usually occurs on artificial turf because it is a more rigid surface that provides less shock-absorbing qualities.

The big toe has two joints. The metatarsophalangeal (MTP) joint is the larger of the two joints. This is where the metatarsal bone in the foot connects with the first bone in the toe. Supporting structures frame this joint and keep it in place. These include fibrous tissues under the MTP joint, ligaments located on the side of the big toe, a tendon that goes under the first metatarsal bone, and two small bones that help this tendon move. These supporting structures form the plantar complex.

What Causes Turf Toe?

During sporting activities, when the balls of the feet are arched, the heel is raised, and considerable power is used to shove off of the big toe turf toe can occur. For example, if an athlete pushes off from a sprint and their toe gets jammed on the ground. When the athlete propels forward, and if the big toe stays flat on the ground and does not rise in association with the lift-off, the big toe may become jammed into a hyperextended position. This motion can cause the ligaments around the big toe to become damaged, stretched, or torn.

What are the Indications of Turf Toe?

Symptoms of turf toe may vary, depending on the extent of the injury. Possible symptoms include:

  • Pain in the front of the foot, particularly tenderness to the touch
  • Bruising in the front of the foot
  • Swelling in the front of the foot
  • Unable to bend the big toe downward
  • A loose toe joint that dislocates easily
  • Inability to put weight on the affected toe

The most common symptoms of turf toe consist of pain, inflammation, and decreased mobility at the base of the big toe. Symptoms can appear in two ways:

  • Recurring strain, symptoms grow slowly and worsen over time.
  • A sudden injury resulting from a sudden movement causing the ball joints of the foot to become shoved into extreme hyperextension. This type of injury can produce severe pain that usually worsens within twenty-four hours. If the bone under the cartilage has been affected, you hear a popping sound at the time of injury.

How is Turf Toe Treated?

A turf toe injury can harm any portion of the plantar complex, producing mild to more severe injuries. A sports medicine physician will determine the turf toe diagnosis, and the patient’s injury will be graded on a scale from one to three by the severity of the injury:

  • Grade 1: Extension of the plantar complex causing tenderness and some swelling in the big toe area of the foot. Utilizing the RICE method (rest, ice, compression, and elevation) is usually recommended for Grade 1 injuries. Anti-inflammatory medicines may be prescribed to alleviate discomfort and swelling. Special orthotics may be used to give additional support can continue training while reducing the stress placed on the plantar joint. The toe may also be taped to other toes to stabilize it and prevent further strain.
  • Grade 2: The plantar complex has been partially torn and produces pain, swelling, and bruising. The range of motion of the toe is limited and is painful to move. For Grade 2 injuries, it’s important to keep the big toe joint completely immobilized. A walking boot can be used for seven to ten days, as needed. Once the boot is removed, the injury is treated as a Grade 1 injury. Athletes with Grade 2 injuries usually require two weeks before being fit to return to their sport.
  • Grade 3: A complete tearing of the plantar complex generating acute pain, bruising, and increased inflammation. Moving the big toe is very painful and difficult. Generally, athletes with a Grade 3 injury may require immobilization for several weeks. A walking boot may be used to keep the big toe pointing partially downward. Upon improvement, the injury may be treated with Grade 2 and then Grade 1 best practices. Full recovery could take up to a year.

Depending on the grade of turf toe diagnosed, the physician will ascertain the best treatment option. Turf toe can usually be treated without the need for surgery.

In cases where an athlete’s performance is significantly affected or where symptoms continue, surgery may be a choice. Typically surgery is recommended for severe Grade 3 cases with:

    • Severe tearing of the plantar plate
    • Sesamoid fracture
    • Unattached bony pieces in the joint
    • Improper vertical movement in the big toe joint
    • Bunions
    • Damage to the big toe cartilage

The kind of surgical procedure used will depend upon the type of injury. The goal of surgery is to repair the ligaments, tendons, and tissues together with restoring the normal function of the big toe joint.

What is the Recovery Progression after Turf Toe Treatment?

Recovery can take four to six weeks. Often, athletes will need to have a hard plate inserted in their shoe to protect the big toe from that motion.
After surgery, physical therapy may be recommended to strengthen the muscles and help restore full mobility of the joint.