Turf Toes

What Are Turf Toes?

Turf toe is a painful injury to the big toe joint (first metatarsophalangeal joint [MTP joint]) often caused by repetitive stress and hyper-flexion of the joint during activity.

Turf toe occurs often when people are playing sports, particularly football players and dancers.

The reason turf toe often occurs in football players is due to flexion required in the big toe joint when playing and the common use of artificial turf, which doesn’t absorb as much shock.

Injuries Considered Turf Toes

The term turf toe describes an injury to the plantar complex of the first MTP joint capsule.

Turf toe covers a variety of injuries that may occur (usually plantar) to the first MTP joint capsule.

Turf toe injury can include:

  • Partial tearing or full thickness tearing to the flexor hallucis brevis tendon
  • Partial/full thickness tearing to the plantar plate ligament
  • Partial/full thickness tearing to the medial and lateral collateral ligaments that exist underneath (plantar) to the big toe
  • Avulsion fracture to the sesamoid bones (the two pea shaped bones underneath the big toe).

What Are The Symptoms Of Turf Toe?

Turf toe symptoms can present mostly as toe pain to the big toe. Specifically turf toe symptoms can present as:

  • Pain to the big toe.
  • Severe tenderness on movement of the big toe.
  • Pain at the big toe when running, walking, jumping etc.
  • Reduced range of motion (limited joint movement) to the big toe.
  • Swelling surrounding the big toe and the forefoot.
  • Redness surrounding the big toe and ball of the foot.

It is recommended to seek medical advice if your symptoms are consistent with turf toe injury so an appropriate diagnosis and treatment plan can be discussed.

There are multiple differential diagnoses that present with these symptoms so it is important to see your podiatrist for a proper assessment so they can provide medical advice.

Causes of Turf Toe

    Turf toe is caused by stressful hyper-flexion to the great toe.

    The trauma can be caused by repetitive injury to the big toe during sport or by one stressful and traumatic event of hyper-extension to the first metatarsophalangeal joint.

    Turf toe is often seen in football players because of the repetitive flexion required at the joint, in combination with playing on artificial turf.

    This surface reduces shock absorption and stability when playing on the field.

    Turf toe is also seen in other sports, and also commonly in ballerinas due to the repetitive flexion to the great toe and the high impact nature of the sport.

    Common Turf Toe Questions

      What Can Be Done For Turf Toe Recovery?

      Turf toe rehabilitation should include physical therapy in the form of stretching and strengthening exercises.

      In order to prevent turf toe from returning it is important to build strength in the feet through physical therapy and to wear appropriate footwear that helps provide support to the foot, and absorb shock.

      Dry needling can be useful to address any muscle tightness after the healing process has completed. Dry needling can help lengthen any tight muscles to prevent further injury and foot problems.

      It is important to review with your podiatrist after the injury has healed to formulate a rehabilitation program to prevent further injury or re-injury to the foot.

      How Is It Diagnosed?

      Turf toe injuries should be diagnosed by a health professional. For a professional diagnosis your podiatrist, doctor, sports medicine doctor, or physical therapist.

      Diagnosis for turf toe injuries will often start with a physical examination of the injured foot. The health professional will likely ask questions about the nature of the injury to find out how the injury occurred. The professional will likely observe the range of motion at the big toe joint to assess if there is limited joint movement. They may also observe any redness or swelling. Often imaging tests may be requested to get a better view of the plantar complex of the first MTP joint to appropriately diagnose turf toe.

      Turf toe can be graded into 3 categories of diagnosis:

      • Grade 1: Injury or sprain to the plantar complex of the big toe.
      • Grade 2: Partial tear to the plantar plate or other tissue at the plantar complex of the big toe.
      • Grade 3: Full thickness tear to the plantar plate or other tissue at the plantar complex of the big toe.

      For grade 3 injuries, a referral to an orthopaedic surgeon (foot and ankle surgeon) may be appropriate to assess the need for surgical treatment.

      How Is Turf Toe Treated?

      There are different stages to treating this injury. Turf toe treatment is often dependent on the severity of the condition and the patient’s goals of treatment.

      For severe cases of turf toe, orthopaedic surgeons (foot and ankle surgeons) may be able to provide treatment advice for the injury.

      However it is often only recommended to seek surgical intervention after more conservative methods have been considered.

      Treatment options can be categorised into three levels when treating turf toe: 

      Level 1: This is basic treatment that focuses on resting the injury. This is often recommended for grade 1 injuries, and often for grade 2 injuries as well.

      • RICE (rest ice compression and elevation). This is to allow the injured foot time to heal.
      • Wearing shoes that are appropriate to the individual’s foot type. For turf toe specifically, these shoes should be cushioned at the front. Stiff soled shoes and footwear with a rocker sole are ideal for this injury.
      • Anti-inflammatory medications – it should be noted that these help manage the symptoms but don’t speed up recovery. These medications can be useful to control pain as the injury heals.
      • Avoid training on hard surfaces. This can reduce shock on the foot as the healing process is underway.

      Level 2: This level of treatment is considered for slightly more severe injuries and persistent cases but is still considered conservative.

      • Orthotics: it can be recommended to wear inserts to control the stress at the 1st mtp joint and therefore improve active rest. Orthotics can be custom made or prefabricated (off-the-shelf). Prefabricated orthotics will likely need to be at least modified by a podiatrist to be appropriate for this injury. Custom orthotics are often more comfortable and easy to wear, as well as allowing the podiatrist to have more control over the supportive and shock absorbing structures.
      • Turf toe plate: this can be added on to prefabricated or custom orthotics, or perhaps worn on its own. This is an addition to footwear that can reduce range of motion at the
      • Walking boot: A special walking boot may be an available treatment option to help the area recover while the patient is still remaining active.

      Level 3: This level of treatment is usually recommended for grade 3 injuries.

      • Surgical treatment: Performed by orthopaedic surgeons, these specialists may be able to repair torn ligaments. Surgical opinion is recommended for severe cases and those cases that are persistent and painful.

      Shockwave Therapy

      Shockwave is a great alternative to treatments such as dry needling if you’re needle phobic and not keen on dry needling. We also have effective treatment offers for kids.

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      Orthotics

      If you experience foot, knee or leg pain in your daily activities then a professionally fitted custom orthotic could be the answer to your foot problems.

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      Dry Needling

      Dry needle therapy can be very effective in treating a range of conditions including chronic muscle pain, neuromuscular problems, and sports injuries.

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