A turf toe is a sprain of the big toe’s main joint. This injury occurs when the big toe is forcibly bent upward, which is referred to as hyperextension. This can occur when pushing off into a sprint from the turf and having the toe get stuck flat on the ground.
Who gets turf toe?
Which toe structures are affected with turf toe?
The big toe has two joints. The largest joint of the toe is called the metatarsophalangeal joint (MTP). The MTP is where the first long bone of the foot (metatarsal) meets the bone of the toe (phalanx). With turf toe, the MTP joint is injured. The joint has many structures that form the plantar complex. These include:
- Plantar plate – Thick fibrous tissue lying beneath the MTP joint. This prevents the big toe from bending too much.
- Flexor hallucis brevis – Attaching to the toe bone, this is the tendon that runs under the first metatarsal bone. This structure provides stability and strength of the big toe.
- Collateral ligaments – These are located on each side of the toe, and they connect to the metatarsal bone to the phalanx bone. These structures prevent the toe from going too far to either side.
- Sesamoid bones – These two small bones are surrounded by the flexor hallucis tendon, and they help the toe move easily, provide stability to the MTP joint, and assist with weight-bearing on the forefoot.
How common is turf toe?
In a study of NCAA football players, the incidence of turf toe injuries was 0.062 per 1,000 athlete exposures. Football players were 14 times more likely to sustain a turf toe injury during games than during practice. Less than 2% of these injuries require surgical intervention.
How is turf toe diagnosed?
- Grade 1 – The plantar complex is stretched causing slight swelling and tenderness.
- Grade 2 – There is partial tearing of the plantar complex causing tenderness, swelling, and bruising.
- Grade 3 – There is complete tearing of the plantar complex causing severe tenderness, swelling, and bruising.
During the exam, the doctor checks for range of motion, as well as swelling and bruising. The doctor will order x-rays to visualize the bones, and magnetic resonance imaging (MRI) scans for viewing soft tissues and cartilage.
What causes turf toe?
Turf toe occurs when the forefoot is fixed on the grown with the heel raised, and a force pushes the big toe into a hyperextended state. This injury can also occur during a forceful tackle.
How is grade 1 turf toe treated?
The RICE protocol is first-line treatment for grade 1 turf toe injuries. This includes:
- Rest – Taking a break from sporting activities, avoiding walking, and not bearing weight on the affected toe.
- Ice – Use of ice packs for 20-minute intervals several times each day.
- Compression – Wearing an elastic compression bandage.
- Elevation – Elevating the affected toe to decrease swelling.
In addition, taping the big toe to other toes (buddy taping) will restrict motion and improve healing. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce swelling and relieve pain. The athlete should use orthotics when returning to activity, such as a phraphite shoe insert with a stiff forefoot component.
How are grade 2 turf toe injuries treated?
For grade 2 injuries, the MTP joint is kept immobilized, and a walking boot is used for 7-14 days. For most athletes, a full 2 weeks of rest is recommended before returning to activity.
How is grade 3 turf toe treated?
For severe MTP joint injuries, the toe is immobilized for 3-4 weeks. The athlete uses a walking boot or cast that keeps the big toe in a downward position. Physical therapy is used to stretch and strengthen the big toe and to prevent joint stiffness.
Is surgery required for turf toe?
Surgery is required for:
- Severe tearing of the plantar complex
- Vertical instability of the MTP joint
- Loose bone chips of the joint
- Fracture of the sesamoid bone
- Damage to the joint cartilage
- New or worsening bunion
OSPI offers the top sports medicine orthopedic treatment in Arizona. The Gilbert orthopedic surgeons are experts in both the nonoperative and operative treatment of injuries such as turf toe. Most insurance is accepted, call today!
George E, Harris AH, Dragoo JL, & Hunt KJ (2014). Incidence and risk factors for turf toe injuries in intercollegiate football: data from the national collegiate athletic association injury surveillance system. Foot Ankle Int, 35(2):108-15. doi: 10.1177/1071100713514038.