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   Immobilization

Treatment Introduction

When you suffer from a moderate to severe case of turf toe, the pain can be debilitating and your big toe can become stiff. Your physician may recommend immobilizing your big toe for one to two weeks. A common method of immobilization is a stiff, steel-soled shoe, possibly with a rocker bottom. The rocker bottom uses a roll bar under your arch so you can step with a rolling motion instead of bending your foot and ankle. The steel sole does not bend, which means your big toe cannot bend when you walk. Your big toe also may be taped to enhance the immobilization. Tape typically is wrapped around the top of your big toe and attached to the ball of your foot. Your physician may prescribe crutches to help you keep weight off your toe for one to two weeks.

Turf toe is a difficult injury to heal and you may be at a high risk for suffering repeat turf toe injuries. Be sure to give your toe ample rest at home before engaging in activities. It is important to let your big toe rest so your tendons and ligaments can heal. For moderate, grade II turf toe, you may need to rest your big toe for two to four weeks. Wear the stiff-soled shoes prescribed by your physician as often as possible. If your toe is taped, your physician will give you specific instructions on how often to change the tape. In general, you should keep the tape dry and have it changed by a qualified physical therapist or athletic trainer. You should ice your toe for about 15 minutes three or four times a day. A common ice treatment is to rest your toe on top of an ice pack. Non-steroidal anti-inflammatories often are prescribed to relieve pain. Try to walk on your injured foot as little as possible for the first few days. Even when wearing your stiff-soled shoes, every time you step, your big toe bends slightly upward and strains the tendons and ligaments. Keep your foot elevated and try to avoid strenuous household chores. After one to two weeks in a stiff-soled shoe, you may be able to return to normal shoe wear. Your physician usually prescribes a stiff shoe insert made of steel, plastic, or custom molded thermoplastic. These solid inserts limit bending of your big toe.

Rehabilitation

Though recovering from turf toe often can be done without formal physical therapy, you may want to visit a physical therapist to receive heat treatments, such as whirlpool baths. A therapist also can give you ultrasound therapy, which sends energy waves through your toe to help ease pain. In general, you should undergo a cardiovascular training program that progresses slowly. When you begin normal shoe wear about two weeks after your injury, you can usually begin light exercise. Depending on your degree of pain, you can progress from walking to running. As your pain diminishes, walking becomes easier. Increase your activity level slowly as you can tolerate the pain. You should start jogging before you return to running. Running should be pain-free before you return to cutting, jumping, and sprinting. You may be able to return to sports and activities within four weeks. If the pain in your big toe flares up while training, you should visit your physician. Turf toe is especially tough for athletes during the middle of a season. Even after treatment and rehabilitation, returning to competitive sports after the injury often causes pain in your big toe. Many athletes can manage their pain through the season by wearing shoe inserts and taping their toes. At the end of the season, if you still have pain, your physician may be able to recommend further treatment. Physicians generally do not recommend corticosteroid injections. Though these injections may ease pain, they may put you at risk for further injury, such as a tendon tear. Corticosteroids should not be used to mask pain so you can return to sports before your toe has healed.

Turf toe can become a chronic condition. People who suffer turf toe typically can return to action, but there is no cure for the condition. You usually can play sports relatively symptom-free with proper protection. The longer you participate in competitive sports and activities on hard surfaces, the greater the chances are that you will reinjure your big toe. The most important preventive measure is to wear a stiff-soled shoe. In athletics, cleats seem to work better because they usually have a built-in plastic sole that is more rigid than a tennis shoe. Your physician may recommend avoiding activities on hard surfaces like artificial turf. Sports like soccer or baseball that are played on grass can be easier on your toes. Wear the stiff shoe inserts prescribed by your physician in all your shoes, whether you are going for a short walk or playing a soccer game. Have a trainer or physical therapist tape your big toe before engaging in competitive sports and activities. Your major concern is to avoid arthritic deterioration of the cartilage where your big toe meets your foot. Continue to visit your physician if symptoms flare up. With proper medical care, most people can prevent reinjury and continue playing comfortably, at close to 100 percent, even though they may have an arthritic toe.