Locations
What is turf toe?
Turf toe is basically a sprain or hyper-extension of the main joint in the big toe. It often occurs when the toes forcefully press against the ground as the foot moves forward. If the surface isn’t shock-absorbent, like pavement or turf, it can cause trauma and injury. Turf toe is sometimes called a jammed or sprained toe, but the condition is more specific than those terms.
More specifically, turf toe is an injury to the main joint of your big toe, known as the metatarsophalangeal joint (MTP), and the plantar complex in the ball of the foot. Located at the base of your big toe, the plantar complex includes the MTP joint along with the tissues, ligaments, and tendons that connect the metatarsal bone in your foot to your toe bone.
What causes turf toe?
Turf toe can occur on any hard surface, but it is most common in sports that involve artificial turf and light, flexible shoes. These light shoes don’t provide much support around the toes, while the firm artificial turf puts extra pressure on them.
It is common among football or soccer players who frequently compete on turf, which is firmer and less shock-absorbent than natural grass, hence the name turf toe.
While this injury can happen in the smaller toes, the American Academy of Orthopaedic Surgeons generally classifies turf toe as an injury to the big toe.
On hard artificial surfaces, the toes are more likely to stay fixed or stick when you push off than on soft natural grass. Think about a sprinter preparing to take off, with their toes on the ground and their heel raised. This motion can cause the toe to be forced upward, increasing the risk of a toe sprain. The footwork involved in football, soccer, rugby, and basketball can increase your risk of developing turf toe due to injury or overuse.
Studies confirm that turf toe is the third most common injury among college athletes on the bench, followed closely by knee and ankle injuries. Beach volleyball players, with their strange need to be barefoot while playing, suffer the same injury—but they call it “sand toe.”
Any part of the plantar complex can sustain an injury, and the severity of the trauma determines the injury grade.
- Stretching of the plantar complex is classified as grade 1.
- A partial tear is considered a grade 2 injury.
- More severe injuries are classified as grade 3 and typically involve a complete tear within the plantar complex.
What are turf toe symptoms?
Turf toe, like other sports injuries, can range in severity and symptoms. The mildest cases typically present as a slight sprain, characterized by joint pain, swelling, and bruising.
In more serious cases, you might hear a “popping” noise at the moment of injury. This sound could be caused by soft tissues, such as the flexor hallucis longus tendon tearing or a fracture of the sesamoids—the small bones at the base of the toe where ligaments and tendons attach. As a result, your range of motion could be limited. The most severe cases can also involve a dislocation of the joint.
Symptoms of turf toe can include:
- Pain, usually around the ball of the foot
- Swelling
- Reduced range of motion and inability to bend the big toe
- Bruising
- Loose big toe joint
- Inability to bear weight on the injured toes or foot
A sports medicine doctor or a skilled foot and ankle specialist, like Dr. Bob, will perform a physical exam and use X-rays to assess the extent of the damage to your toe. Depending on the severity, your healthcare provider may suggest different treatment options.
What conservative turf toe treatment options does Dr. Bob use?
Most cases of turf toe injuries heal with conservative treatments, which can include:
- Immobilization of the big toe joint in a splint or walking boot with the toe pointing down, allowing the plantar plate to heal in a stable position
- RICE (rest, ice, compression, and elevation)
- Over-the-counter anti-inflammatories, such as ibuprofen
- Physical therapy exercises to increase the range of motion
If the case is mild, turf toe recovery may only take two to three weeks with proper treatment. If parts of your plantar complex are completely torn, orthopedic surgery might be necessary.
What are the surgical treatments for turf toe?
Surgery might be recommended if there’s cartilage damage or bone deformity caused by the injury, or to relieve ongoing pain and swelling. Dr. Bob will select the most suitable surgical option based on the severity of damage to your toe or ligaments.
If only the ligaments are torn, the soft tissue can be sewn back together end-to-end with strong sutures or bone anchors. If there is a traumatic bone deformity, bone cuts might be necessary to reposition and realign the joint. If articular damage exists, Dr. Bob may choose to perform a cartilage transplant or microfracture surgery to regenerate cartilage in the joint.
After turf toe surgery, the toe is typically immobilized in a cast to promote healing and recovery. However, this can lead to joint stiffness.
Fortunately, a new technique called amniotic membrane injection is available to reduce scarring and stiffness in the joint. The amniotic membrane possesses regenerative properties that help reduce scarring after surgery, resulting in less stiffness.
Preventing turf toe complications
First and foremost, after a turf toe injury, do not rush your return to sports! Turf toe is known for its persistent symptoms, and you don’t want a temporary sprain to turn into a long-term issue. Surprisingly, half of all athletes who injure their turf toe still experience symptoms up to five years after the injury.
The main point is to avoid pushing your big toe against unyielding surfaces. Choose shoes with stiffer soles or add shoe inserts to help prevent the toe from forcibly bending at the MTP joint. Stiff-soled shoes and inserts can protect the big toe joint, as can taping the ball of the foot.
Additionally, it’s best to play on well-maintained fields rather than those with unexpected holes and divots. If possible, alternate between hard and softer surfaces, such as turf and natural grass, to help reduce impact and trauma on the big toe joint.
Dr. Bob Baravarian is the top choice for athletic foot injuries in Los Angeles
Dr. Bob has extensive experience in treating foot and ankle injuries, including turf toe. He utilizes the latest technologies to deliver the most accurate diagnoses and treatments, helping you return to your normal activities as quickly as possible.
By offering a full range of diagnostics, conservative and surgical treatment options, physical therapy, and in-office imaging, he provides comprehensive care in a state-of-the-art setting without the need to visit multiple locations.
Dr. Bob Baravarian is conveniently located in Los Angeles, near Cedars-Sinai Medical Center, providing expert foot and ankle care for patients throughout Southern California.
