“Turf toe” means that the strong fibrous ligaments connecting your big toe to your foot have been stretched too far and have been “sprained.” This most commonly happens when your big toe is extended forcibly toward the top of your foot. This may happen abruptly from a fall or when something lands on the back of your calf while your toes are touching the ground. Turf toe commonly occurs from jamming your big toe into a hard surface. Occasionally, the injury happens over a long period of time from repetitive stress- like pushing off of the big toe each time you run or jump.
The term “turf toe” was coined because this injury became more common in athletes with the implementation of artificial turf fields. Turf toe injuries rank third after knee and ankle injuries among the most common cause for lost playing time in athletes.
A turf toe injury causes pain and swelling at the base of your big toe. You will notice your pain probably increases when your toe is straightened or bent backward toward the top of your foot. Sometimes you may notice bruising shortly after the injury. Gout, a type of arthritis that is more common in men, can sometimes act like turf toe. Be sure to tell your doctor if you or someone in your family has a history of gout.
Early treatment is focused on keeping your toe from moving too much. Depending upon the severity of the injury, turf toe usually requires a period of rest for proper healing. When directed, you may begin non-weight bearing activities, such as stationary cycling or swimming. You should take a close look at your shoes before returning to play. Wearing excessively flexible shoes on a turf field increases your chance of injury. Consider a stiff-soled shoe or hard carbon fiber insert during initial healing. When you are able to run and change directions without pain or loss of mobility, you will likely be allowed to return to play. Be sure to ice your toe for 10-15 minutes following any activity while your injury is healing.
Turf toe is a hyperextension injury of the first toe causing capsular sprain to the first MCP joint. The patient will usually present with a history of forced dorsiflexion of the first toe. The injury may be from acute injury or repetitive strain. It may result from trips or falls. Sometimes, the injury occurs when someone or something falls on the back of the calf while that leg’s knee and tips of the toes are touching the ground. The injury is common in athletes. The term “turf toe” was coined because of the increased incidence of these injuries associated with the implementation of artificial turf on athletic playing fields. A similar condition caused by a forced plantarflexion injury to the dorsal capsule is called “sand toe”. It is common in sports played on sand, such as beach volleyball.
Turf toe may be associated with significant morbidity. Turf toe injuries rank third, after knee injuries and ankle injuries, among the most common injuries causing loss of playing time among university athletes. While ankle injuries are up to 4 times as common as turf toe injuries, turf toe may account for a significantly greater proportion of missed playing time.
Electrotherapy and ice or underwater ultrasound may be helpful to diminish acute pain and swelling. Clinicians should address lower limb, foot and ankle restrictions with joint manipulation. IASTM may be performed over the affected ligaments to speed healing. Stretching will begin with active range of motion as symptoms allow. Stretching and myofascial release to the gastrocnemius and soleus is necessary to ensure adequate ankle dorsiflexion, thereby minimizing re-injury to the MCP.
Treatment is based upon the RICE (Rest, Ice, Compress, Elevate) principle to reduce pain & swelling and protect the toe from further injury. Selective rest may be necessary and could include stationary cycling. Ice should be applied 3-5 times per day at home. Patients may find relief with NSAIDs. Stretching of the gastrocnemius and soleus will improve dorsiflexion of the kinetic chain. Clinicians should assess the need for orthotics and evaluate shoes. Athletes wearing flexible turf shoes are much more prone to injury than those wearing shoes containing a stiff forefoot. The absence of a stiff sole places the forefoot, and specifically the MTP joints, at much greater risk for stress-type injuries Athletes should avoid shoes with an excessively flexible forefoot and consider stiff soled shoes during initial healing. Players may also consider using an insole containing a carbon fiber steel plate in the forefoot. Clinicians may consider taping of the toe to prevent dorsiflexion reinjury. Grade III sprains usually require immobilization in a cast or boot for 1-2 weeks followed by 4-6 week of activity modification/ rest.
When the athlete can run and change direction without pain and loss of mobility, he or she may return to participation with the toe taped and a rigid insert.