Turf Toe Injury Overview

Turf toe is a type of toe injury that most commonly affects football players, but almost any athlete can suffer from it. Turf toe occurs when the ligaments around the big toe joint become sprained, causing pain, stiffness, and reduced mobility. Luckily, there are many ways to treat turf toe, or prevent it from happening in the first instance. Read on to learn more.

What is Turf Toe?

Turf toe is a sprained ligament around the big toe—an area known as the plantar complex secondary to hyperextension, when the toes bends backwards beyond its normal limits. The medical term for turf toe is a metatarsophalangeal (MTP) joint sprain of the big toe.

Turf toe most commonly occurs in people who engage in the following activities:

• Ballet
• Basketball
• Football
• Martial arts
• Rugby
• Running
• Wrestling

That’s because these sports involve repeatedly pushing off the big toe with force (such as with running or jumping) or slamming the feet onto a hard surface.

Turf toe is so-called because it typically affects athletes who play on artificial turf. The turf is much firmer than real grass, easier to grip in athletes wearing cleats, and it’s also more slippery in wet weather. These conditions mean players are more prone to injuring their toes when they slip or jam their feet on the ground.

Turf Toe Injury Grades

Different grades of turf toe sprain are used to describe how severely the ligament is damaged. Grading injuries in this manner allows doctors to devise the most effective treatment plans for each patient.

• Grade 1 Turf Toe

  A grade one injury involves the least amount of damage to the plantar complex of the big toe joint. Typically, the ligament is stretched, but not torn. Symptoms at this grade include localized tenderness and minor swelling.

• Grade 2 Turf Toe

  At this level, the ligament has a partial tear. It causes tenderness around the plantar complex, along with moderate swelling and bruising. People with grade two tears experience pain and limited range of motion in the toe.

• Grade 3 Turf Toe

  A grade three injury is the most severe type of turf toe. The ligament is completely torn, causing symptoms like severe pain, swelling, tenderness, bruising and increased risk of toe dislocation. It is very difficult or impossible to move the toe and compromise the entire joint capsule. Recovery from a grade three injury takes significantly more time than recovery from grade one or two damage.

What Causes Turf Toe?

A turf toe injury occurs when you bend the big toe too far upward, toward the top of the foot—an action known as hyperextension. This movement can damage the entire plantar complex, including:

• Collateral Ligaments
  

  Bands connecting the toe bones and keeping the big toe in position.

• The Flexor Hallucis Brevis
  

  A tendon that supports the big toe when running or jumping.

• The Sesamoid Bones
  

  Two small bones at the front of the foot that act as a pulley for when pushing off with the big toe

• The Plantar Plate
  

  A connective tissue structure that keeps the big toe from hyperextending.

Risk Factors

Although anyone can injure their toe if they trip or slip, some people are more likely than others to experience turf toe. Factors that increase the risk of the condition are known as risk factors.

Some of the main turf toe causes and risk factors include:

• Engaging in activities that require repeated pushing off the big toe and forefoot, such as running and jumping
• Getting tackled and leaving the big toe flat on the ground
• Falling forward and leaving the big toe flat on the ground
• Exercising on hard and artificial surfaces
• Having increased range of motion in the ankle (particularly dorsiflexion)
• Slipping on a wet surface and bending the toe upward
• Wearing shoes without adequate sole support
• Wearing shoes that are too flexible around the toes

Common Symptoms

The most obvious symptom of turf toe is pain in the plantar complex, the area around the bottom of the big toe. You may also notice pain in the joint that runs along the foot toward the ankle.

Turf toe pain may come on gradually, as in the case of repetitive injuries. But a sudden and severe hyperextension can cause the immediate onset of pain. This type of turf toe pain typically gets worse over the following 24 hours.

Other turf toe signs and symptoms include:

• A popping sound or sensation (in cases of sudden injury)
• Bruising
• Stiffness and tenderness in the big toe and surrounding area
• General sensitivity in the ball of the foot
• Pain when weight is applied to the ball of the foot
• Swelling around the toe
• Limited range of motion in the plantar complex (the distal big toe joint)
• Inability to “push off” the big toe with running, walking or jumping

Some people are unsure if they have turf toe or gout (a type of arthritis), as the symptoms are somewhat similar. Pain that comes and goes—lasting for a few days at a time—suggests gout. Turf toe is also more specific to active athletes participating in high impact activities. The only way to be sure is to see your doctor for a diagnosis.

How it’s Diagnosed

To diagnose turf toe, your doctor may carry out a physical examination to check for bruising, redness, and swelling of the plantar complex. They will test your toe’s range of motion and check to see how much that motion causes you pain. He or she will probably compare your injured foot to your uninjured one.

Evaluation

A doctor will usually ask you when you first noticed the pain, along with any other symptoms you have to help narrow down the cause. They may also inquire about your:

• Sporting activities
• Job
• Hobbies
• Chosen footwear
• Medical history

Imaging Tests

Doctors can use these imaging tests to get a better look at the structures in the foot.

• X-rays for Turf Toe

  X-rays are used to rule out the presence of a fracture or other bone abnormalities. Usually, people will have an X-ray of the front, back, and sides of the foot. Sometimes, the radiographer will also take an X-ray of the healthy foot to make comparisons.

• MRI for Turf Toe

  An MRI imaging scan allows the doctor to see the soft tissues of the foot, including the ligaments and tendons in the metatarsophalangeal joint (MTP) joint. Your doctor may order an MRI scan based on your symptoms, or following an X-ray that rules out bone damage.

Possible Complications

Rarely, turf toe can cause complications, such as:

• Long-term stiffness that can result in bunions, ankle sprains, etc. 
• Permanent joint or toe damage
• Reduced ability to run or jump

Turf Toe vs. Gout

While at first glance, it may appear that turf toe and gout have the same symptoms, there are some differentiating factors to consider. Cause is a big factor. If you are an athlete or participate in high impact activities and can pinpoint a cause of your injury, you most likely have turf toe.

Characteristics of Gout

Gout is caused by a build of uric acid crystals in the joints, most often beginning with the big toe. Here’s what to look for with gout.

• It is more common in men
• Correlated to genetics and unhealthy lifestyle choices, such as a diet high in meat, processed foods, and alcohol. 
• Onset is typically sudden and severe and does not require any mechanical injury. 
• Someone suffering from gout may experience generalized symptoms in multiple joints 
• A hallmark sign of gout is the shiny swollen appear of the top of the foot.

If you are not active, have a family history of gout, or can’t recall a cause for an injury, or display some of the common characteristics below, you may be dealing with gout. Follow-up with your sports medicine doctor or podiatrist for further medical advice.

Dealing with Turf Toe

Although there isn’t an instant turf toe cure, many professional treatments , such as physical therapy, and turf toe home remedies successfully alleviate symptoms and facilitate gradual healing. Grade one turf toe injuries heal quickly, while grade two and three sprains can take longer. You can speed up your recovery time and avoid complications by using turf toe boots or a walking boot for immobilization, shoe inserts, taping, crutches to reduce weight-bearing, and splints, and working with a physical therapist. You may also need anti-inflammatory medications to help manage swelling and pain initially. Get started today on your treatment, and you'll be walking confidently soon!

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