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Turf Toe

The simplest definition of turf toe is that it is a sprain of the main joint of the big toe.

General Information:

It happens when the toe is forcibly bent up into hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground. 

Turf toe can occur in any sport or activity when the forefoot is fixed on the ground, the heel is raised, and a force pushes the big toe into hyperextension.

These injuries most often occur among American football players on artificial grass. Artificial surfaces tend to be harder and less shock absorbent. In addition, the athletic shoes designed for artificial surfaces are softer and more flexible, providing the athlete with more agility, but much less stability in the forefoot.

What is the treatment for Turf Toe?

The RICE protocol is effective for most sports ­related injuries when they first occur. RICE stands for Rest, Ice, Compression, and Elevation.

  • Rest. Take a break from the activity that caused the injury and avoid walking or putting weight on your foot.
  • Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
  • Compression. To help prevent additional swelling, wear an elastic compression bandage.
  • Elevation. To reduce swelling, recline when you rest, and put your leg up higher than your heart.

What is the non-surgical treatment?

Most cases of turf toe are treated without surgery. Nonsurgical treatment is determined by the grade of the injury.

  • Grade 1. The RICE protocol is recommended for this type of injury: Rest, ice, compression, and elevation. Taping the big toe to the smaller toes will restrict motion. Non­steroidal anti­inflammatory medications may relieve pain and swelling.Pain is usually tolerable and an athlete can continue sports participation using a stiff­soled shoe. Orthotics, such as a thin, graphite shoe insert with a rigid forefoot component, can reduce stress on the plantar plate and provide stability.
  • Grade 2. To keep the MTP joint immobilized, a walking boot may be prescribed for up to a week if needed. Afterward, these injuries are managed with a taping regimen and the Grade 1 treatments discussed above.In most cases, an athlete with a Grade 2 injury needs 3 to 14 days of rest before returning to play.
  • Grade 3. These more severe injuries are most often treated with immobilization for several weeks. The athlete may wear a walking boot or be put in a cast that keeps the big toe in a partially pointed down position.As the injury heals, treatment will gradually step down to Grade 2 and then to Grade 1.

Physical therapy may be helpful and should be started as soon as symptoms allow. Specific exercises will help to stretch and strengthen the big toe. Early joint movement is essential for reducing or preventing joint stiffness.

What is the surgical treatment?

Surgery is not often necessary for treating turf toe. However, if your symptoms persist or your level of athletic play is affected, surgery may be an option. Doctors most often recommend surgery for larger Grade 3 injuries, such as:

  • A severe tear of the plantar complex
  • Fracture of the sesamoid
  • Vertical instability (unusual up and down motion) of the MTP joint
  • Loose bony chip in the joint
  • Damage to the cartilage of the joint
  • New or worsening bunion

The surgical procedure will vary according to the injury. The aim of surgery is to repair the soft tissues and restore the MTP joint motion so that normal function can be preserved.