What Is Turf Toe?
Turf toe is an injury to the big toe. The bottom of the large knuckle of the big toe is stretched, causing swelling, bruising, and pain in your big toe. It is a fairly common sports injury, particularly among athletes who play on artificial turf, such
as football players.
The metatarsophalangeal (MTP) joint is the largest joint in the big toe and is where the long bone of your foot (metatarsal) connects with the smaller bone of your toe (phalanx). Ligaments, tendons and two tiny bones called the sesamoids surround this
joint and hold the toe in place. An important ligament on the bottom forms the "plantar plate." All these structures together form the "plantar plate complex," which keep the toe stable when pushing off, such as when walking or running. Turf toe injuries
involve damage to one or more parts of the plantar plate complex. Treatment depends on the severity of the injury.
Those with turf toe often experience swelling, bruising, pain, tenderness, limited joint movement, and difficulty applying weight to the big toe. Usually the injury occurs with a very sudden and forceful extension of the toe. Turf toe injuries can be
classified as mild (grade 1), moderate (grade 2), or severe (grade 3). Sometimes turf toe is caused by repetitive injury or overuse. In this case the symptoms may start out as mild but can worsen with continued activity.
Turf toe injuries are graded by their severity:
Grade 1 injury: The plantar plate complex is stretched, resulting in tenderness and some swelling but no bruising.
Grade 2 injury: Partial tearing of the plantar plate complex occurs, resulting in increased tenderness, swelling, and bruising on the bottom of the foot. It also becomes more difficult for you to move your toe.
Grade 3 injury: The plantar plate complex completely tears, causing severe tenderness, swelling, bruising, and trouble moving your big toe. You may feel like your toe is out of place or dislocated.
The big toe joint acts like a hinge, allowing you to push off. Turf toe occurs when your big toe bends too far and stretches the tissue on the bottom. When the big toe extends past its normal limits, the plantar plate complex can stretch or tear.
Common causes of turf toe include participating in sports that involve changing direction (especially on artificial turf), wearing the wrong type of shoes when playing sports, and wearing high heels or walking in a manner that puts a lot of pressure on
the big toe.
When evaluating for turf toe, your foot and ankle orthopaedic surgeon will ask how the injury took place. If the symptoms developed gradually, your surgeon will ask for specifics on when they began and any activity that makes them worse. The doctor will
also ask about your occupation, your participation in athletics, the type of shoes you wear, and any history of foot problems.
Your surgeon will then examine your foot, comparing the injured foot to the uninjured one. X-rays may be taken to rule out broken bones or other injuries. Sometimes your surgeon will also request an MRI to get a better look at the plantar plate complex.
A diagnosis will be made based on the results of these tests and the physical examination.
The treatment of turf toe will depend on the severity of the injury.
Grade 1 treatment usually involves protecting the toe in addition to rest, ice, compression, and elevation. Your surgeon may recommend over-the-counter oral medication such as ibuprofen to reduce swelling and control pain. Your surgeon may also recommend
wearing stiff-soled shoes and using athletic tape to help keep the toe still. This treatment protects the toe and gives the injury time to heal. As symptoms improve, your surgeon will provide individualized advice on returning to sports gradually
and increasing your activity level over time.
Grade 2 treatment generally requires a special walking boot, often along with taping the big toe. Surgery is typically not required. You may wear a walking boot for 2-6 weeks before progressing to the grade 1 injury treatment methods described above.
Sports and dress shoes are resumed with comfort, usually around 6-8 weeks.
Grade 3 treatment involves limiting motion for a more extended period. This generally includes wearing a walking boot as healing takes place. You may need surgery. If you do not have surgery, you may be in a walking boot or cast for 6-8 weeks. After the
boot is removed, your surgeon may recommend physical therapy in order to regain range of motion and strength in the injured toe. Return to sports and dress shoes can take 2-3 months.
Surgical treatment for turf toe is rarely necessary except in the competitive athlete. For competitive athletes, surgery may be recommended to repair the damaged ligaments and tendons, keep the bones aligned properly, and prevent disability. Surgery is
more likely if your toe dislocated, indicating a severe tear of the plantar plate complex. You also might need surgery if the injury doesn’t heal properly. The type of surgery depends on the extent of the injury and the tissues that were damaged.
With early intervention, most turf toe injuries are treated successfully. It is common for athletes to recover from turf toe and return to their prior level of activity. Make sure to check with your foot and ankle orthopaedic surgeon and athletic trainer
before returning to sports.
It is important to take preventive measures to decrease the likelihood of a repeat turf toe injury. The simplest way to prevent reinjury is to wear shoes with stiff soles that support the big toe. This can help stop the
toe from bending excessively. Your surgeon may prescribe special shoe inserts that help prevent the toe from bending too far backward. A physical therapist or athletic trainer may also work with you to correct any problems and develop techniques for
training or playing sports to help prevent future turf toe injuries.
Risks and Complications
Turf toe can result in long-term stiffness, pain, and even deformity in your big toe if it is neglected or improperly treated. It is important to perform at-home exercises to help decrease stiffness and pain.
When should I see a doctor about turf toe?
While turf toe injuries are often mild, you should make an appointment with your foot and ankle orthopaedic surgeon if it is too painful to walk on the affected foot, if there is a lot of swelling and bruising, or if physical activities, such as running
and playing sports, become difficult.
Original article by Erik Freeland, DO
Contributors/Reviewers: David Porter, MD; Elizabeth Cody, MD
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