Feet > Turf Toe

What is Turf Toe?

Turf toe is the term used to describe a sprain in the tendons or ligaments in the ball of your foot that occurs where your big toe meets the foot. Turf toe is usually caused by your toe being bent too far back, or when your toe is jammed forcibly into the ground. Turf toe can be so painful that you cannot play sports with it at all. Turf toe usually damages the joint capsule where the base of your big toe connects to your longer midfoot bone (first metatarsal). When your big toe bends too far backward, the tendons, cartilage, or bone in your big toe’s joint with your foot (first metatarsophalangeal joint) can be injured. Your big toe’s joint with your foot has a complicated structure. Underneath this joint lies the ball of your foot, which covers two smaller bones, called the medial and lateral sesamoids. Like your kneecap, these sesamoid bones act as a kind of lever to make movement in your big toe more efficient. Tendons attached to your sesamoids help pull your big toe downward, enabling you to stand up on your toes and push off when you start to run or jump. Turf toe commonly is an injury to the capsule surrounding the sesamoids or the tendons attached to your sesamoids. However, each case of turf toe can have different facets, such as bone, cartilage, or ligament damage throughout the joint. Turf toe can be classified into three grades of injury:

   Grade I – Stretching in the joint capsule, tendons, or ligaments that move your big toe.

   Grade II – Partial tears in your big toe’s joint capsule, tendons, or ligaments.

   Grade III – Tears in your big toe’s tendons or ligaments and possibly damage to the bone and cartilage surface on the base of your big toe or the end of your long midfoot bone.

Improper footwear makes an athlete more susceptible to turf toe. Also, although turf toe can happen when playing on grass fields, the strong grip of artificial turf causes the majority of serious big toe injuries. This risk is enhanced by the fact that many athletes wear soft-soled tennis shoes that offer no toe protection when playing on artificial turf. Football players, especially linemen, most commonly suffer turf toe. They put a lot of strain on their big toes when they push off the ground at the line of scrimmage and often are involved in pile-ups in which other players may fall on their feet. Though turf toe can occur when your toe is bent too far in any direction, it commonly occurs when your big toe is bent upward. The tendons and ligaments that pull your toe downward are stretched too far and can tear. Turf toe also can be caused by overuse, but most people can recall a particular incident when their big toe was bent too far, or hyperextended. Severe turf toe injuries that cause cartilage and bone damage usually are a combination of hyperextension and compression. For example, your big toe can bend upward too far while another athlete falls on your foot, which jams the ends of the bones in your big toe and foot together.

Considerations

Athletes who suffer turf toe usually can return to action, but there is no cure for the condition. Most people can treat turf toe without surgery, with a combination of rest, ice, medication, and stiff soled shoe inserts. You remain at risk for suffering repeated turf toe injuries and your physician typically prescribes preventive toe taping when you participate in sports and activities. More severe turf toe injuries that damage the bones in your toe may require your foot to be immobilized for a few weeks. If left untreated, turf toe can cause bone spurs to develop around the toe joint that may need to be surgically removed. Removing the spurs can bring pain relief, but many times this does not address the cause of the bone spurs, and arthritis can still result. Surgery rarely is prescribed to treat turf toe unless you suffer from other complications such as arthritis, repeat injury, or chronic pain.

Orthopedic Evaluation

There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

MEDICAL HISTORY

Your physician likely will ask about your activities, which may have injured your big toe. You will probably be asked when the soreness or pain began and if you recall hyperextending your toe recently. If you have had any prior turf toe injuries, your physician will ask about the treatments you have tried in the past. Physicians also typically ask about other conditions, such as diabetes and allergies, and medications currently being taken. You may also be asked about your physical and athletic goals – information that will help decide what treatment might be best for you in achieving those goals.

Physicians can often diagnose turf toe by putting direct pressure on the ball of your foot, around where your big toe meets the foot. Your toe is usually tender when pressure is applied, and pain tends to increase when your toe is bent upward. Some swelling may be visible around your toe joint. Your physician also may examine your gait as you walk around to check for a limp. Turf toe often makes it difficult to push off with your toes as you begin to step.

TESTS

X-rays of your big toe commonly are taken from different angles so your physician can check for bone damage at your big toe’s joint with your foot. Small bone chips may be present in the X-ray that can indicate compression fractures. Severe cases of turf toe may have slightly dislocated your big toe, which may be seen in an X-ray. MRI (magnetic resonance imaging) may be given when X-rays do not show any bone damage. MRI may be able to reveal soft tissue damage that is causing your pain.