During sprints and jumps the big toe bends and extends (pushes off) to propel the body forward. Repeated small pushes or one large forceful push can irritate the soft tissues around the MTP joint and cause turf toe.
Most turf toe injuries heal well with taping or inserts and physical therapy. However, left untreated turf toe can lead to long-term stiffness and weakness of the push-off.
Symptoms
Turf toe is a sprain in the big toe joint (the metatarsophalangeal, or MTP, joint). This large joint connects the base of your big toe to the rest of your foot. It’s held in place by ligaments and tendons that attach to your bones. A MTP joint injury can range from a mild sprain to a complete dislocation of your big toe.
Symptoms include pain in the base of your big toe that gets worse when you put pressure on it. Bruising can develop around the toe and up to the top of your foot. Depending on how your injury happened, you might feel a snap or hear a pop when it occurred. Your provider will ask about your symptoms, how they developed and what activities aggravate them. They will also check the base of your toe for tenderness and compare it to your uninjured big toe. They might order an X-ray or an MRI to see the damage to your bones, ligaments and tendons.
Most turf toe injuries are minor, especially if you get treatment right away. Your provider will recommend a combination of rest, ice, compression and elevation (the RICE protocol). Over-the-counter nonsteroidal anti-inflammatory medication (such as ibuprofen) can help control pain and swelling. Keeping your injured foot elevated and icing it every 20 to 30 minutes can reduce swelling and help your injury heal faster.
Diagnosis
Symptoms include pain and tenderness in the big toe. It may hurt most when pressure is put on the toe. Bruising and swelling are also common. The injury is often made worse by running or playing sports.
Turf toe is a sprain of the largest joint in your big toe. This is the metatarsophalangeal (MTP) joint, where the first long bone in your foot (metatarsal) meets the first bone in your toe (phalanx). A complex set of structures support this joint, including ligaments, a tendon called the flexor hallucis brevis, and two tiny sesamoid bones.
Your child’s healthcare provider will diagnose turf toe with a physical exam. They will gently press on the toe and move it around to check for swelling and stability. They may order X-rays to make sure there is no fracture in the big toe bone or any other problems with your child’s bones or joints. They may also order an MRI scan, which gives them better pictures of soft tissues like cartilage and ligaments.
Your child should rest from activities that cause pain in the big toe. They should use ice packs several times a day, especially right after activity. They can also try using a special insert in their shoe to help support the big toe. Their doctor may recommend physical therapy to improve strength and flexibility in the big toe and feet.
Treatment
Turf toe is the name for a type of injury that occurs when your big toe bends up too far. Specifically, the first metatarsophalangeal joint (1st MTPJ) gets forcibly bent upward into hyperextension. This forcible movement happens during many weight bearing activities like running, jumping or dancing and especially when you are wearing cleated shoes on surfaces that are less forgiving than grass.
The 1st MTPJ is designed to bend upward and there are two small bones in this area called sesamoids that act as miniature pulleys assisting with toe motion. However, the flexor hallucis tendon attaches to both the big toe and these sesamoids and if this tendon is fixed in a position that causes the big toe to bend upward or hyperextend it can cause damage to the ligaments in the big toe joint.
A health care provider can diagnose turf toe by examining your big toe and looking at the toe joint for signs of bending, twisting or pushing upward against it. Your healthcare provider may also order imaging tests to assess the severity of your injury.
Treatment includes resting your foot, avoiding excessive putting weight on the toe and taking ibuprofen or acetaminophen for pain. Your doctor may recommend taping your big toe to your smaller toes for stability. Physical therapy is also helpful and will include exercises to decrease stiffness of the big toe joint.
Prevention
Turf toe is a sprain of the main joint in your big toe, called the metatarsophalangeal (MTP) joint. It occurs when your toe is forced into hyperextension, or bent up more than it should be, usually during sports activities. This puts stress on the ligaments and soft tissues in your toe, which can cause them to stretch or tear. This injury is most often associated with sports that require running and jumping, especially those played on artificial turf surfaces, where the surface is harder and less forgiving than grass. It is most common in football players, but it can affect people who participate in other athletic activities, such as basketball, dance and gymnastics.
The risk of this injury increases when the toe is repeatedly stressed over a long period of time. Practicing proper techniques for movements that involve the toe, and emphasizing good body mechanics, can help reduce the likelihood of hyperextension. Being mindful of the playing surface and footwear can also help prevent this injury by ensuring that the toe is supported adequately and not subjected to excessive stress.
Proper warm-ups can also improve the flexibility and stability of the toe joint, preventing it from being forced into hyperextension. Wearing shoes that provide adequate support and cushioning can also decrease your risk of getting this injury. Lastly, incorporating strengthening exercises into your regular fitness routine can strengthen the muscles that support the toe, making them more resilient against injuries.