Toe > Treatments
Severe turf toe can be
a season-ending injury. It may cause bone spurs or loose
bodies in your big toe’s joint with your foot,
which can hinder your toe’s movement and cause
pain. Surgery to remove the bone spurs or loose bodies
may be necessary to relieve turf toe pain. You may become
a candidate for surgery if you have suffered turf toe
in the past and conservative treatment has failed to
relieve your symptoms. Bone spurs in your big toe joint
are your body’s response to cartilage damage in
the joint. When the cartilage is damaged, your body
forms bone spurs as a sort of roadblock to movement
in the joint space between your big toe and the longer
midfoot bone (first metatarsal). If the joint cannot
move, the bones cannot grind into each other as much.
However, moving your big toe can cause pain and activities
can become difficult. Your surgeon can cut away the
bone spurs, restore movement in your big toe, and relieve
The actions you take before surgery can be every bit
as important as the procedure itself in ensuring a healthy
to your return home from the hospital, make sure that
you have received any equipment you will need when you
get home. This may include crutches or household items
to make movement around the house easier. You should
receive prescriptions for any of these from your doctor
before you go home from the hospital.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
reduce the risk of infection, improve healing, and decrease
complications, try to quit smoking or decrease the amount
you smoke. In general, smokers have a higher rate of
infections and complications.
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
a second opinion from another qualified surgeon is often
advisable, particularly in rare or unique cases.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will go to "patient
admissions" to check in for your operation. There
may be separate check-in areas for ambulatory outpatient
(patients go home the same day after surgery) and for
overnight inpatient surgery, so be sure to ask your
doctor or an assistant about this. After you have checked
in to the hospital, you will go to a holding area where
the final preparations are made. The mandatory paperwork
is completed, and your foot may be shaved, though this
is not always necessary. You will be asked to change
into a hospital gown and, if applicable, remove your
watch, glasses, dentures, and jewelry. You typically
have a chance to meet the whole surgical team, including
the nurses, before the procedure begins. You will have
the opportunity to speak with your orthopedic surgeon
or an assistant and meet the anesthesiologist or nurse
anesthetist (a nurse who has done graduate training
to provide anesthesia under the supervision of an anesthesiologist).
Then, you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This helps
reduce the risk of vomiting while you are under anesthesia.
for someone to drive you home when you are released.
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your toe-immobilizing
shoe when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Surgery to remove bone spurs or loose bodies from your
big toe usually takes about 1 1/2 hours to perform.
A regional ankle block anesthesia is injected into your
ankle to numb your foot and you usually are sedated
so you sleep through the procedure.
incision about three centimeters long usually is made
along the top of your big toe.
surgeon inspects your big toe’s joint with your
foot. Bone spurs often grow from the small bones in
the ball of your foot called the sesamoids.
loose bodies or bone spurs that are hindering joint
movement are cut away, or excised, so that your big
toe’s joint can move normally.
or ligaments that have torn can be sewn together.
incision is closed with stitches. A plaster splint is
applied to immobilize your toe, and you are taken to
the recovery room.
After surgical excision of bone spurs in your big toe’s
joint, you will be transported to the recovery room,
where you will be closely observed for one to two hours
while the immediate effects of anesthesia wear off.
Your foot will be elevated and your big toe immobilized
in a splint when you wake up. The soft dressings covering
your big toe help to hold it steady. After surgery,
you will experience some pain and adequate pain medications
will be prescribed for you. You may be given intravenous
(IV), oral, or intramuscular pain medications as needed.
Your surgeon will prescribe crutches, and you are usually
instructed to keep weight off your big toe for one to
two weeks. Your foot is placed into an open-toe sandal
with a hard plastic bottom so your toes cannot bend.
This post-surgery shoe is removable but should be worn
as often as possible. Your temperature, blood pressure,
and heartbeat will be monitored by a nurse who, with
the help of the doctor, will determine when you can
prepare to go home. You normally leave the hospital
or clinic the same day after surgery, sometimes within
four hours. If you experience a lot of pain, you may
be admitted for an overnight stay after surgical repair
of your peroneal tendons, but this rarely occurs. Make
sure to have someone available to drive you home, as
you will be unable to drive a car.
After surgical excision of bone spurs
from your big toe, you may need to be on crutches for
one to two weeks. Rest as much as possible with your
foot elevated above the level of your heart. This helps
blood drain away from your big toe and can control swelling.
It is essential to keep weight off your foot for the
first few days. Everyone heals at a different pace,
so use your crutches to test how much weight you can
bear without pain. As pain decreases, you will rely
less on the crutches over the course of about two weeks.
Always wear the stiff-soled sandal prescribed by your
physician when you put any weight on the injured foot.
Recovery is easier when you have someone around the
house who can help with any physical chores. You will
most likely return to your physician’s office
within seven to ten days to have your stitches taken
out. Follow up visits generally are scheduled for sometime
around two weeks, six weeks, and then three months after
surgery, depending on your specific problem and healing
time. Most patients can return to normal shoe wear in
three to four weeks. Physicians typically prescribe
stiff shoe inserts that limit the bending in your big
toe. You may visit on orthotist to have the inserts
molded to fit your foot. When prescribed, these inserts
should be worn in all your shoes, all the time. Taping
your big toe can also help relieve pain. Your physician
can help you find a trainer or physical therapist qualified
to tape your toe. Your physician may suggest physical
therapy that can be done at home, or refer you to a
physical therapist to help strengthen your toe and lower
Recovering from turf toe surgery
can often be done without formal physical therapy. In
general, you should undergo a cardiovascular training
program that progresses slowly while wearing the stiff-soled
inserts prescribed by your physician during all physical
activity. You may be able to return to sports and activities
within six weeks. If the pain in your big toe flares
up while training, you should visit your physician.
You may want to visit a physical therapist to receive
special treatments if you want to return to sports faster.
Physical therapists can offer a combination of the following
treatments after toe surgery:
treatments – Whirlpool baths and heating pads
can help ease pain and warm up your tendons and muscles
– High-frequency energy waves pass through your
toe and heat tissue deeper in the joint. Ultrasound
may help promote blood flow through your big toe’s
joint with your foot.
– Physical therapists often can help you select
shoes that have the appropriate support and shape for
– To further limit your big toe’s motion,
physical therapists are trained to wrap tape around
your toe and midfoot to help hold your toe steady. The
taping is elaborate and physicians typically recommend
you let a therapist tape your foot instead of trying
to do it yourself.
of motion – A physical therapist can stretch your
toe in different directions and instruct you in the
proper techniques for stretching at home.
– Special exercises for the smaller foot muscles
include picking items off the floor with your toes,
toe curls, and toe movement in a bucket of sand or rice.
training – Physical therapists can help you overcome
a limp that may have been bothering you before surgery.
exercises – To restore balance, physical therapists
have you train on a BAPS board, which is a board balanced
atop a ball. You also may be asked to perform exercises
while balancing on one leg.
When your injured toe has the same strength as
the other toe and your range of motion returns to normal,
it is usually safe to return to sports and activities.
A good test of toe strength is to run in figure-eight
patterns. If your big toe continues to hurt when you
cut in different directions, you should continue rehabilitation
Turf toe can become a chronic condition.
People who suffer turf toe typically can return to action,
but there is no cure. However, you usually can reduce
the symptoms and 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. Once you have suffered
turf toe, it is a good idea to use the stiff shoe inserts
to limit bending in your big toe. 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.