Overview

What is turf toe?

Turf toe, also known as a metatarsophalangeal joint sprain, occurs when the ligament under your large toe hyperextends, spraining the main joint of your big toe.

What do symptoms of turf toe look like?

Turf toe symptoms can be mild or severe. If the injury from a sudden blow caused turf toe, you might have heard or felt a "pop" when the injury occurred. Pain in your toe from a sudden injury typically starts within minutes.

In contrast, turf toe symptoms from repetitive injuries often develop gradually and worsen with time. Symptoms of turf toe include:

• Pain and tenderness: You may have steady pain within your toe, or the pain can only be provoked if you massage over that particular area. You might not be able to put much weight on your big toe due to its intensity.
• Swelling and bruising: The bottom area of the large toe may swell. Bruising can extend around your swollen toe and even up to the top of your foot.
• Limited mobility: You may not be able to move the toe or bend it up and down. You may feel that the foot is weak or that you cannot push off the ground like before.
• Loose joint: The MTP joint feels like it can pop out of place, and it actually does. The MTP might actually be loose and not properly stabilized.

What causes turf toe?

A turf toe injury is when your big toe is bent and pressed flat against the ground. The heel is usually well off the ground, like a sprinter's starting position. There can be significant force placed on the big toe during incidents that hyperextend it or bend it beyond its natural range of motion. Ligaments, tendons, and soft tissues in the joint will stretch or tear.

Turf toe develops due to several repeated movements over time. For instance, a ballet dancer may develop it from her jumps. The injury can also develop from sharp traumas like when one tackles an opponent and one's toe is planted on the ground. It has been observed that most athletes who make such sudden foot movements in changes of direction acquire this type of injury.

How is turf toe diagnosed?

The doctor will ask you to provide the history of the injury and will examine the toe and apply pressure on the tender area. The doctor may require you to move your toe to test the range of motion in the joint. If the injury occurred suddenly, ask your provider how it happened. Try to recall as many details as you can remember about how your toe was planted and where you felt pain.

Your provider will order an X-ray and, if needed, an MRI (magnetic resonance imaging) scan. These tests take pictures of bones, ligaments, tendons, and soft tissues to check for any damage in your bones and soft tissues.

What is the treatment for turf toe?

There are three grades of a turf toe injury. Treatment will vary depending on the classification of the injury.

Grade 1

Grade 1 injuries, the least severe of the three, can be treated at home using the RICE method:

• Rest: Avoid activities that may aggravate your injury and allow your toe to rest so that the sprain can heal.
• Ice: Apply an ice pack in a plastic bag on the area. This will minimize swelling and inflammation.
• Compression: Bandage your foot and toes using a bandage. Taping your big toe to the other toes will restrict movement and, hence, excess complications with the injury.
• Elevation: Lie down with your foot up, which enhances fluid draining and reduces swelling.
• Over-the-counter anti-inflammatory medication, such as NSAIDs, may help you manage your pain until it heals.
• Wear a shoe that will not bend so easily to prevent you from bending your toe again.

Grade 2

Grade 2 injuries are a bit more serious. They usually require crutches or a walking boot to allow the foot to heal and protect it.

Grade 3

A grade 3 injury may need surgery to address it in case a break in the bone, a tear of a ligament, or major joint damage occurs.

The type of surgery needed depends on what part of your plantar complex requires treatment.

If the soft tissue, either the ligament or the joint capsule, is torn, your surgeon will stitch those tissues together using sutures. Sutures are stitches for body tissues.

In case your doctor determines that there will be a fracture of one or more bones, then he or she must repair the broken one. You would then be required to carry a cast for a certain period to protect the toe and allow it to heal completely.

Can I prevent turf toe?

However, you cannot always avoid turf toe, especially when it arises from an accident. You minimize your chances of getting turf toe by wearing shoes that are stable enough for your activity. Football and soccer players must particularly avoid shoes with too loose toe area.

Before you begin exercising in a sport or physical activity, warm up and stretch. Warm muscles and soft tissues are much less likely to be injured. Talk to your provider if you engage in sports such as football, gymnastics, or ballet, which may place you at higher risk for turf toe. A physical therapist can assist you in developing recommendations on how you may best prevent your likelihood of becoming injured.

What is the prognosis for a person diagnosed with turf toe?

Most people with turf toe do not have any problems for a long time after an injury is treated. However, a person may still be left with stiffness, weakness, or pain in the joint of the big toe (hallux rigidus). In very rare situations, your big toe sticks up from the others, and you can't lie the front part of it flat on the floor when you are standing.

When should I call my doctor about turf toe?

Call your doctor if you have the following symptoms: Pain, swelling, or bruising of your toe or foot. Even if the pain is minor, you should see your provider so he or she can recommend the appropriate treatment. Seek your provider right away if your pain is severe, if you cannot put any weight on your foot, or if the toe joint appears to be dislocated.

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