Turf Toe

What is turf toe?

A turf toe is a sprain of the largest joint of your big toe. It happens when your toe forcibly bends upwards, such as when you push off into a sprint.

Your big toe has 2 joints. The metatarsophalangeal (MTP) joint is the largest of these. This is where the first long bone of your foot (metatarsal) connects with the first bone of your toe (phalanx). Important structures surround this joint and hold it in place. These include fibrous tissues under your MTP joint, ligaments located on the side of your big toe, a tendon that runs under your first metatarsal bone, and 2 tiny bones that help this tendon move. Together, these supporting structures form the plantar complex.

A turf toe injury can damage any part of the plantar complex, causing mild to more severe injuries. Healthcare providers grade these injuries by their how bad they are. In a grade 1 injury, trauma stretches the plantar complex. This causes soreness and slight swelling. In a grade 2 injury, partial tearing of the complex causes worse soreness, swelling, and bruising. It also becomes hard to move your toe. In a grade 3 injury, your plantar complex completely tears. This causes severe soreness, swelling, bruising, and trouble moving your big toe.

Turf toe got its name because the injury became more common when football players began playing on artificial turf instead of grass. Artificial turf is harder and less shock-absorbent than grass. It is particularly common in professional athletes who play football or other sports on artificial turf, but it also occurs in a wide variety of sports and activities. It is relatively uncommon in people who are not athletes.

What causes turf toe?

Turf toe typically happens when you have your toe planted on the ground and your heel raised. Turf toe happens if you apply a force to your toe that makes it angle upwards more than it should. For example, it may happen if you are pushing off from a sprint and your toe gets stuck on the ground.

Who is at risk for turf toe?

You are more likely to get turf toe if you do athletic activities involving surfaces with artificial turf. You also may be more likely to get turf toe if you use a soft, flexible shoe, instead of a shoe that gives more support to the front of your foot. Most commonly this injury is seen in football players. But people who play soccer, basketball and wrestling can get this injury. Also people who do gymnastics and dance are at risk.

What are the symptoms of turf toe?

Symptoms of turf toe may vary, according to the extent of your injury. Possible symptoms include:

• Pain in the front of your foot, especially soreness to the touch

• Swelling in the front of your foot

• Bruising in the front of your foot

• Inability to bend your big toe down

• A loose toe joint that dislocates

• Inability to put weight on your toe

How is turf toe diagnosed?

Your healthcare provider will start with a health history. They will ask about your current symptoms, past medical problems, and how you injured your foot. They will examine your foot to check for bruising, swelling, and range of motion. If this is painful, your provider might inject you with a numbing medicine.

Imaging can help diagnose turf toe as well. Your healthcare provider will order X-rays to make sure you don’t have any problems with your bones. To get a better look at the plantar complex, they might order an MRI. This is particularly useful in grade 2 or grade 3 injuries. An emergency room healthcare provider or a general healthcare provider often diagnoses you. But you also might see a healthcare provider who specializes in bones of your skeleton (orthopedist) or a provider who specializes in the foot and ankle (podiatrist).

How is turf toe treated?

Your treatment may vary according to the severity of your injury. If you have only very mild symptoms, like in a grade 1 injury, you might not need to see a healthcare provider. You can treat yourself by doing the following:

• Rest from the activity that caused the injury.

• Use cold packs for 20 minutes at a time, several times a day.

• Use an elastic compression band to help prevent additional swelling.

• Elevate your leg to limit swelling.

• Take over-the-counter pain medicine. Don't exceed the advised dose.

If your symptoms persist, it’s important to see a healthcare provider. You’ll also need to see a healthcare provider right away if your symptoms are more severe.

If you have a grade 2 injury, your healthcare provider might prescribe the above. They may also advise a hard shoe or walking boot to help keep your joint immobilized for 1 week or so after your injury.

If you have a grade 3 injury, you will probably need immobilization for several weeks. This might involve a walking boot or a cast. If you have a grade 3 injury, you may need surgery as well. This might be more likely if you have a severe tear of your plantar complex, or if your joint is unstable. You also might need surgery if your injury doesn’t heal as expected.

If you have turf toe, you will probably benefit from physical therapy. Exercises can help stretch and strengthen your big toe.

What are possible complications of turf toe?

Turf toe may cause long-term stiffness and pain in your joint. Do all your physical therapy exercises as advised. They can help decrease stiffness and pain.

How do I manage turf toe?

If you are an athlete, check with your healthcare provider and trainers to see when you might be ready to return to your sport. If you have a grade 1 injury, you may be able to play very soon after the injury. If you have a grade 2 injury, you may need to be out of play from a few days to a couple of weeks. For a grade 3 injury, you will probably not be able to return to your sport for a couple of months as your injury heals. Full recovery may take up to a year.

When you are ready, your healthcare provider or trainer can advise specific shoes and shoe inserts to give your foot more support. Taping your big toe to your other toes may provide extra support as well. It’s important not to return to your activity too soon. This increases your chances of injuring your toe again.

When should I call my healthcare provider?

See your healthcare provider soon if your symptoms do not improve. See them right away for significant symptoms, like high fever, deformity, numbness in your toe, or if your toe feels cold and looks pale.

Key points about turf toe

• A turf toe is a sprain of the main joint of your big toe. This is the metatarsophalangeal (MTP) joint. Trauma damages the support structures known as your plantar complex. It happens when your toe forcibly bends upwards, such as when pushing off into a sprint.

• Turf toe is more common in athletic activities that are done on artificial turf.

• You might have symptoms like bruising, swelling, pain, and inability to move your toe from your injury.

• Most people with turf toe will not need surgery. Your healthcare provider may treat your injury with rest, ice, compression, elevation, pain medicines, and immobilization.

• Some people with more severe turf toe injuries may need surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions, especially after office hours and on weekends and holidays.