Turf Toe

CAUSES

Turf toe is an umbrella term for injuries affecting the joint that connects the great toe to the forefoot and occurs when the big toe is hyperextended (bent toward the knee). Turf toe injuries are most often seen in football, soccer, basketball, rugby, and wrestling, but they can occur in all sports where running, cutting, and jumping occur.

DIAGNOSIS

Tenderness over the joint and increased pain with toe extension is the primary symptom. An X-ray is often recommended to rule out a fracture. The athlete should apply ice and not bear weight until a fracture is ruled out. If no fracture is present, an MRI may be obtained to gauge the extent of soft tissue and ligament damage. Turf toe injuries range in severity from grades 1-3. A grade 1 sprain is characterized by localized tenderness, mild swelling, and mild pain with range of motion. A grade 2 sprain is characterized by widespread pain and tenderness, moderate swelling and possible bruising, and moderate pain with range of motion. A grade 3 sprain is usually a complete rupture and is characterized by severe tenderness and instability, moderate to severe swelling and bruising, and severe pain with restricted range of motion.

SYMPTOMS

Once an athlete hyperextends the toe, they will complain of sharp pain, decreased toe range of motion, and toe stiffness. They may report hearing or feeling a “pop”. The athlete may be tender where the great toe meets the forefoot.

TREATMENT

Once a diagnosis is made, the athlete is usually placed in a rigid-soled shoe or walking boot to prevent toe hyperextension and facilitate healing. Depending on the severity of injury, the athlete may be placed on crutches. Conservative treatment of the turf toe will consist of ice, anti-inflammatory medication, and possibly physical therapy. Acute physical therapy may consist of ice, heat, ultrasound, gentle range of motion activities, and progression to strengthening and functional/sport activities. Most cases take a few weeks before an athlete can return to play. In cases where severe pain, decreased range of motion, or MTP joint instability persist, surgery may be indicated to repair the torn ligament and capsule. Once the athlete is cleared to return to athletic activity, preventative measures should be taken, such as taping the toes, using an orthotic devise in the shoe and using regular therapy to flex the toe muscles.