Like a sprained ankle, turf toe is a condition that deals with hyperextensions (sprains) that occur to the big toe joint, also known as the metatarso-phalangeal joint (MPJ). It most commonly occurs when the toe is jammed forcibly or when it is bent backwards too far. In severe cases, the sesamoid bones and flexor tendons are also hyper-extended and injured. Turf toe got its name from the fact that it happened mostly to athletes who played on turf fields. But turf toe can happen to anyone who bends their big toe awkwardly or beyond its limits. Any sport or activity that requires repetitive pushing off from the toes—such as dancing, jumping, or running—can result in turf toe.
Turf toe can also happen to people who do not participate in sports. A simple stubbing or jamming of the toe can result in this condition. Everyone is susceptible to turf toe, but doctors usually see more male patients than female.
Turf Toe Symptoms
These are the symptoms of turf toe:
- Pain at the base of the big toe
- Swelling of the toe and ball of foot
- Popping sound can be heard or felt at time of injury
- Limited movement of the toe
- Reduced mobility
- Bruising around the ball of the foot and along the top of the big toe
- Tenderness when touched
Not everyone experiences these symptoms, but most people complain of pain at the base of the big toe. If you have recently stubbed or jammed your toe, you may have turf toe. Pain and other symptoms are usually mild at first, but they gradually worsen.
Turf Toe Causes
Turf toe usually occurs during athletic events, and it is especially common in sports played on artificial turf. Artificial turf is the perfect material for a foot to stick to. The injury usually happens when the foot sticks while the rest of the body continues forward. Because artificial turf has such a strong grip, many athletes wear soft-soled shoes, which offers little or no protection to the forefoot. Contributing factors to turf toe can include:
- Direct injury leading to damage of the bone beneath the cartilage
- Prior injuries, especially to toes and forefoot
- Your positioning while playing sports
- Range of motion (ROM) in your ankle
Diagnosing Turf Toe
If you think you may have turf toe, you should seek medical help immediately. To make the correct diagnosis, your foot doctor will probably ask you questions about your personal and family medical history, symptoms, and activities that may have led to the condition. He or she will also perform a visual examination of your toe. In most cases, your doctor will take x-rays to ensure there are no broken bones or additional damage to the toe or surrounding tissues. If your doctor is still unable to make a proper diagnosis, he or she will used advanced imaging studies such as MRI or a bone scan to draw a conclusion. Turf toe injuries are typically diagnosed and graded in this way:
- Grade 1: Minimal swelling, localized tenderness, and no bruising
- Grade 2: Mild to moderate swelling and tenderness; some bruising
- Grade 3: Range of motion is painful and limited; moderate to severe bruising and severe tenderness and swelling
Turf Toe Treatment
The most common treatment for turf toe is rest. This means keeping weight and pressure off the toe throughout the healing process. Often the RICE method is used (Rest, Ice, Compression and Elevation). RICE is a great way to treat foot injuries. Your doctor may also recommend a simple over-the-counter pain and inflammation reducer such as ibuprofen. If you have to be upright, your doctor may require you to tape your injured toe to the other toes for support and stability. Sometimes doctors place the entire foot in a cast or special walking boot to keep the toe from moving, and on occasion crutches are used.
For most cases, it takes two to three weeks for the pain to subside. After that time, some patients will need to participate in physical therapy to reestablish motion, mobility, strength, and conditioning of the big toe.
Treatment may also be as easy as wearing the proper footwear. Football players often wear shoes that are too tight, which increases the risk of turf toe. Simple changes such as improving one’s footwear can prevent turf toe.
Complications of Turf Toe
Turf toe, even if it is properly treated, has been known to cause long-term problems, including hallux rigidus, hallux valgus, and failure to regain push-off strength. Short-term complications include compromised push-off and running abilities, and players frequently miss games due to the injury. Turf toe can also lead to hyperflexion injuries.
Preventing Turf Toe
Here are some tips to help you prevent turf toe:
- Wear shoes that offer protection, especially in the toe box
- Wear cleats instead of tennis shoes, since they usually have built-in plastic soles
In many cases, the proper footwear can prevent turf toe and other injuries to your toes and feet. Here are some stretching exercises that may be beneficial for your toes:
- Pencil Pick-Up: This exercise requires you to place a pencil on the ground in front of you while you are seated in a chair. Using your toes, pick the pencil up and hold it for a few seconds at a time. Repeat this exercise ten times. Items such as marbles can also be used for this exercise.
- Toe Walking: You want to do this exercise slowly at first. Stand on your tip toes and walk ten to fifteen steps at a time. Once you get good at doing this, increase your distance from ten to fifteen steps to twenty to twenty-five steps, and so on.
Questions to Ask Your Doctor
Here are some questions you may want to ask your doctor about turf toe:
- What type of surfaces will not cause turf toe?
- During the healing process, how much should I limit my activities?
- What are the chances I will suffer the effects of turf toe in the future?
- What type of shoes should I wear during my sports activities?
- Do you have a brochure I can take home to read more about this condition?
- Are there additional symptoms I should watch for that may indicate treatment is not working?
- What else can I do to prevent turf toe from recurring?