Turf Toe

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What is Turf Toe

Turf toe is an injury that affects the joint at the base of the big toe. It occurs when the toe is bent upward by force and extended beyond its normal limits (hyperextension). The joint of the big toe is surrounded by tissues (ligaments and tendons) that help to keep it in place. If any of these tissues are damaged, turf toe may result.

Turf toe is a sprain of the plantar capsule ligament complex of the metatarsophalangeal joint of the great toe. It is more common on artificial turf and results from a hyperextension injury. Hyperflexion and valgus injuries to this toe can cause similar symptoms. Treatment includes rest, taping of the toe to restrict dorsiflexion, and stiffening of the sole of the shoe to prevent motion. Without proper therapy, hallux rigidus can result.

Turf toe is a common sports injury. It can be mild if the tissue was stretched. It may be more severe if the tissue was partially or completely torn. Early treatment usually results in good recovery. In some cases, a person may continue to have some pain, joint stiffness, and reduced ability to push off from the affected foot.

What are the causes?

This injury is caused by extreme upward bending of the big toe joint. It can occur when:

Your toe is pressed flat to the ground and your heel is raised while you push off forcefully with the front of your foot. For example, this could happen when you begin a sprint.
You push off on the ball of your foot repeatedly while running or jumping, especially on hard surfaces such as a basketball court.
You jam your toe from a force pushing into the toe.

What increases the risk?

This injury is more likely to occur in people:

Who wear flexible shoes that do not offer good support while running or jumping.
Who participate in activities or sports that involve running and jumping on turf or hard surfaces, such as:
- Soccer.
- Football.
- Basketball.
- Volleyball.
- Gymnastics.
- Dancing.
- Wrestling.

What are the signs or symptoms?

Symptoms of this condition include:

Pain at the base of the toe.
Swelling at the base of the toe.
Stiffness.
Limited movement of the toe.
Bruising.

If turf toe is the result of a direct injury, symptoms may appear suddenly. If the condition is due to repetitive movements, such as running and jumping, the symptoms may develop gradually and worsen over time.

How is this diagnosed?

This condition may be diagnosed based on your symptoms, your medical history, and a physical exam of your foot. During the exam, the health care provider will check the range of motion of your toe by moving it up and down and from side to side. You may also have tests to confirm the diagnosis, such as:

X-rays to rule out bone problems, such as a fracture, a chip, or bones that are out of alignment.
MRI to view the soft tissue and cartilage in your toe. This will help to determine how severe your injury is.

How is this treated?

Treatment for this condition depends on the severity of the injury. Treatment may include:

Rest, ice, compression, and elevation. This is often called the RICE strategy. It may be recommended if the injury is mild. Your health care provider may also restrict movement of your toe by taping it to the smaller toes.
Wearing a walking boot or a cast. For more serious turf toe, you may need to wear a walking boot for about one week. This will keep your toe from moving (immobilization). If you have severe turf toe, you may need to wear a cast or a walking boot for several weeks.
Over-the-counter medicines to relieve pain.
Physical therapy. Stretching and strengthening exercises can help to reduce or prevent joint stiffness in your toe.
Surgery. In rare cases, surgery may be needed for a severe injury if pain does not go away.

Follow these instructions at home:

Managing pain, stiffness, and swelling

If directed, apply ice to the injured area:
- Put ice in a plastic bag.
- Place a towel between your skin and the bag.
- Leave the ice on for 20 minutes, 2–3 times per day.
Move your toes often to avoid stiffness and to lessen swelling.
Wear an elastic compression bandage to help prevent or lessen swelling.
Raise (elevate) your foot above the level of your heart while you are sitting or lying down.
If you have a walking boot, wear it as told by your health care provider.
Do not use the injured foot to support (bear) your body weight until your health care provider says that you can. Use crutches as told by your health care provider.

Medicines

Take over-the-counter and prescription medicines only as told by your health care provider.
Do not drive or operate heavy machinery while taking prescription pain medicine.

If you have a cast:

Do not put pressure on any part of the cast until it is fully hardened. This may take several hours.
Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
Check the skin around the cast every day. Report any concerns to your health care provider. You may put lotion on dry skin around the edges of the cast. Do not apply lotion to the skin underneath the cast.
Do not let your cast get wet if it is not waterproof.
Keep the cast clean.

General instructions

If your cast is not waterproof, cover it with a watertight plastic bag when you take a bath or a shower.
Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
Switch to less-flexible, more supportive footwear as told by your health care provider. Rigid shoe inserts (orthotics) can also reduce stress on your toes and improve stability.
Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

You have new bruising or swelling in your toe.
The pain in your toe gets worse.
Your pain medicine is not helping.

Get help right away if:

Your cast or walking boot becomes loose or damaged.
Your pain becomes severe.
Your toe becomes numb or changes color.
Your toe joint feels unstable or is unable to bear any weight.

Turf Toe Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your foot. These exercises also help to relieve pain.