Turf Toe

Ever felt pain in your toe area or had trouble moving your big toe? If so, you might’ve suffered from turf toe. This injury is a common occurrence in athletes, but can also happen outside of sports. Let’s delve into what this injury is and how you can treat it.

What is turf toe?

A metatarsophalangeal joint sprain, also known as turf toe, occurs when the ligaments or soft tissues in the big toe are overstretched or torn. Turf toe affects the larger of the two joints in the big toe, called the metatarsophalangeal (MTP) joint. The MTP joint connects the base of the big toe and the rest of the foot. While a turf toe usually involves a simple sprain in the big toe, it can be as severe as a dislocation of the MTP joint.

There are three levels of turf toe, with designated grades based on their severity.

• Grade 1: Soft tissue stretched, but not torn. Sensitivity, mild swelling.

• Grade 2: Soft tissue partially torn. Area is very tender, often swollen and bruised. Moderate pain and limited movement.

• Grade 3: Soft tissue completely torn. MTP joint might be dislocated. Extreme swelling and pain. Toe movement becomes very difficult. Surgery might be required.

A grade one turf toe might slightly limit your ability to play sports, but a grade three turf toe will make it very difficult to move anything.

Causes:

What causes turf toe to happen? Turf toe occurs when your big toe is flat against the ground, while your heel is raised high. This position shifts enough body weight onto the big toe, causing the ligaments to hyperextend past its regular range of motion.

This injury is associated with athletes who practice or compete on an artificial turf, hence the name turf toe. American football players are often the ones to sustain this injury, but it also can occur in basketball players, soccer players, ballerinas, sprinters, or gymnasts. Turf toe can occur from both sudden movements and repetitive movements over time. An example of a sudden movement could be a football player being tackled (shown below). An example of a repetitive movement could be a series of jumps that a ballerina does that puts pressure on the toe over and over again.

An example of how an athlete can sustain turf toe

Symptoms:

Some common symptoms of turf toe include:

• Pain that may radiate from the big toe

• Tenderness in the toe region

• Swelling

• Bruising

• Limited range of motion

• Joint that feels loose

• Stiffness

Treatment:

In most cases, turf toe can resolve itself on its own with proper recovery practices. As with other sprains, you can use the RICE method to treat this injury:

• Rest: Depending on the severity of your injury, you may need to avoid putting weight on your foot for several days or weeks. Your healthcare provider may give you crutches or a walking boot to help with this.

• Ice: Applying ice to your toe for 20 minutes at a time can help reduce swelling and pain.

• Compression: An elastic compression band can help to prevent additional swelling that may occur.

• Elevation: Every couple of hours, relax and elevate your foot above your heart to reduce inflammation in your toe.

Some additional treatment methods include…

• Over-the-counter (OTC) pain medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) help to relieve pain and reduce swelling and can be prescribed by your healthcare provider.

• Physical therapy (PT): A physical therapist can show you exercises and stretches to help you regain mobility and reduce stiffness in your toe.

• Taping: You can use tape your big toe into a flexed position to prevent hyperextension of the 1st MTP joint.

• Orthotics: Orthotics are special inserts that fit into your shoe and help to support your toe joint and keep it stable.

A common taping method for turf toe

Grade one and grade two turf toes usually resolve themselves with lots of time and rest, but grade three turf toes might require surgical procedures to treat. While surgery is rarely needed, it’s often used to fix severe tears, fractures, or joint damage.

Prevention:

Turf toe can be difficult to prevent but risks can be reduced by simply wearing the right shoes. Wearing shoes that provide enough stability whilst avoiding shoes that are too soft or flexible are thus the keys to success. Proper warmup and stretching before physical activity can also help to avoid sustaining a sprain.

Conclusion:

Turf toe involves a sprain in the ligaments of the big toe, caused by excessive extension. Some signs that you may have turf toe include pain, swelling, and loss of mobility. Most of the time, turf toe is a minor injury that can be resolved with rest and time. However, severe cases may need surgery.

Sources:

Saling, Joseph. “Turf Toe: Symptoms, Causes, and Treatments.” WebMD, 13 March 2024, https://www.webmd.com/fitness-exercise/turf-toe-symptoms-causes-and-treatments.

“Turf Toe.” Cedars-Sinai, https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/turf-toe.html.

“Turf Toe - StatPearls.” NCBI, https://www.ncbi.nlm.nih.gov/books/NBK507810/.

“Turf Toe: Symptoms & Treatment.” Mass General Brigham, https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/turf-toe.

“Turf Toe: What It Is, Causes, Symptoms & Treatment.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17590-turf-toe.