Turf Toe

Turf toe is an injury that affects the big toe joint. It happens when the big toe is bent too far or too forcefully. This motion causes soft tissues and ligaments (tissues that connect your bones) in the big toe joint to stretch or tear and sprain. Ligaments are tissues that connect your bones.

Turf toe is common among football players because they frequently push off their toes into a sprint or make sudden movements while running. It is commonly associated with athletes competing on a turf surface, but it can happen to anyone. The injury can occur in various sports and activities, flexible or rigid shoe wear, and turf or flat surfaces.Turf toe injuries increased in the 1970s when football players began playing on artificial turf instead of grass. Artificial turf is a harder surface than natural grass. The increase in the occurrence of turf toe injuries could be because of the use of more flexible, lighter shoes and related to changes in the interaction of the surface with the shoe wear.

Most of the time, the injury gets better with treatments like rest, ice and medications like ibuprofen or acetaminophen. Some turf toe injuries that don’t heal with these treatments may need surgical repair.Make an appointment with the doctor if you have pain, swelling or bruising in your toe or foot. Even if the pain is mild, it’s important to get evaluated and follow the right treatment plan. If pain is severe, there is inability to put weight on your foot or the toe joint looks dislocated, see the doctor immediately.

Symptoms

Turf toe symptoms range from mild to severe. If a sudden injury caused turf toe, a “pop” may be heard or felt when the injury happens. Pain from a sudden injury is usually felt right away.

Turf toe symptoms from repetitive injuries usually appear gradually and get worse over time. Symptoms of turf toe include:

• Pain and tenderness: Pain may be constant, or it may only hurt when you press on the area. Big toe pain may be so severe that you can’t put weight on it.
• Swelling and bruising: The base of the big toe may be inflamed. Bruising can extend around the swollen toe and up to the top of the foot.
• Limited range of motion: You may not be able to move your toe or bend it up and down. You may feel like your foot is weak or you’re unable to push off the ground like before.
• Joint that feels loose: The metatarsophalangeal (MTP) joint may pop out of place or feel like it’s unstable. The joint may also feel stiff.

What causes turf toe?

• A turf toe injury happens when the big toe is bent at a 90-degree angle and pressed flat against the ground. Usually, the heel is high off the ground, like a sprinter’s starting position. If you put too much force on the big toe, you can hyperextend it (bend it farther than it’s supposed to go). Bending the toe beyond its natural range of motion can cause ligaments, tendons, and soft tissues in the joint to stretch or tear.
• Turf toe can result from many repetitive movements over time (like a ballet dancer’s jumps). The injury can also result from sudden trauma, such as when a football player tackles an opponent whose toe is planted on the ground. Athletes who make sudden foot movements and changes in direction are more likely to get this type of injury.

What part of the toe does this injury affect?

• The big toe has two joints. The larger joint is the MTP joint. This joint connects the base of the big toe to the rest of the foot.
• Tendons, ligaments, and connective tissue hold the bones and muscles of the big toe together. These structures provide stability and allow the big toe to move without dislocating. The injury can range from simple sprains to dislocations of the MTP joint.

Diagnosis

• The physician examines the toe and gently pushes on the area to check for tenderness. Range of motion may be tested. The physician will take a medical history including how injury happened and pain felt. 
• To check for damage in the bones and soft tissues, X-ray or MRI scan may be ordered to produce images of bones, ligaments, tendons and soft tissues.
• The physician may classify the degree of injury as follows:

Grade 1: Typically, soft tissue is stretched, but not torn. The area is sensitive when you touch it. It may be mildly swollen. You may have mild limitations with sports and exercises abilities.

Grade 2: The soft tissue complex partially tears. The area has intense and more diffuse tenderness and is often swollen and bruised. You’ll be more limited with sports and exercises.

Grade 3: Soft tissues more completely torn. The MTP joint may be dislocated. Swelling and pain in the toe are severe. It’s very difficult to move the toe, let alone exercise or play sports.

The grading system is used to classify turf toe injuries and determine the most effective treatment.

Treatment

Most sprained toe injuries heal with time and plenty of rest. Grades 1 and 2 turf toe injuries usually get better with noninvasive treatments. Thephysician may recommend:

• Rest: The provider will tell you how long you should avoid putting weight on your foot. Depending on the severity of the injury, a break from sports and activities for several days or weeks may be recommended.   A walking boot or crutches may be prescribed to use while the toe heals.
• Ice and elevation: Every few hours, relax with the injured foot above the heart.  A cold compress to the toe may be recommended for about 20 minutes at a time. Ice reduces swelling and pain. Elevating the toe reduces inflammation.
• Over-the-counter pain medication:  These over-the-counter medications relieve pain and reduce swelling.
• Physical therapy (PT): An experienced physical therapist will prescribe exercises and stretches to help the toe heal. A customized PT program includes exercises to reduce stiffness, improve flexibility and strengthen muscles that support the MTP joint.
• Stabilization: The big toe may be taped to your smaller toes. This turf toe taping technique restricts motion while the toe heals. Sturdy, supportive footwear may also be recommended when returning to sports.
• Orthotics:  Orthotics are special inserts that fit into the shoeand stabilize and support the toe joint.These may be recommended in certain situations.
• Surgery: Rarely, a turf toe injury requires surgery to repair severe tears, fractures, or joint damage. The type of surgery depends on the injury's location and which bones and soft tissues are damaged.

Many people with turf toe do not have long-term problems after recovering from the injury. Others continue to have joint stiffness, weakness or big toe pain.

Prevention

• To reduce risk of turf toe, wear shoes that provide enough stability for sports activity. Football and soccer players should avoid shoes that are too flexible, especially in the toe area.
• Stretching andwarming up before an activity or sport may also help prevent injury. When muscles and soft tissues are warm, they’re less likely to get injured.