Tom Toothaker, PT, DPT
A sprain of the metatarsophalangeal (MTP) joint at the base of the big toe has come to be known as Turf Toe, since artificial turf is now widely used in the world of sports. Artificial Turf is harder and doesn’t have as much “give” as natural grass fields when a force is applied to it, like when falling or pushing off for a sprint or tackle. Although sprains of the MTP joint happened before artificial turf was invented, nowadays this injury happens more frequently, especially to football and soccer players. When the player is holding their ground and digging in their toe for traction, during a tackle, block, or pushing off for a sprint, hyperextension of the big toe joint can occur.
Turf Toe is a simplistic way to describe an injury to an intricate joint system at the base of the big toe called the plantar complex. The plantar complex consists of bones, ligaments, a tendon and soft tissues that can be over-stretched (Grade 1), partially torn (Grade 2) or fully torn (Grade 3) when injured. The symptoms are pain, bruising, swelling and difficulty or the inability to bear weight. The joint may become unstable, dislocate, or bones can be fractured, requiring surgery. Grade 2 or 3 Turf Toe injuries always use Physical Therapy as an integral part of the treatment and rehabilitation plan.
For all Grades of Turf Toe injury, the PRICE Protocol – Protection, Rest, Icing, Compression and Elevation should be used immediately after injury to reduce pain, inflammation, swelling and bruising. An OSC Orthopaedic Physician would determine the grade of injury upon diagnosis and may order x-rays or an MRI to further assess the damage to the joint. The physician may prescribe a special boot or toe immobilizer for the patient to use while recovering.
The Physical Therapist would take all of this into consideration, including the sport played, work, lifestyle, etc. when developing the therapy regimen that is tailored to the individual’s specific needs and goals, as well as following physician-specific protocols for injury treatment.
The goals for treatment are the same for surgical and non-surgical Turf Toe – improve strength and range of motion, while reducing pain, swelling and stiffness. Depending on the severity of the injury and whether surgery was required, Physical Therapy may last for only a few weeks or be needed for to up to a year for the athlete to achieve full recovery.
Here is a typical treatment regimen for Turf Toe: Depending on the severity of the injury, the beginning phase may include taping techniques or a turf toe plate used to limit painful motion. Various modalities could be used (ultrasound, laser therapy, H-wave ESTIM) and treatment techniques, such as Instrument Assisted Soft Tissue Mobilization, dry needling, or cupping to assist with fluid movement, reduction of pain and facilitation of movement. Exercises are performed to restore passive, then active motion. Strength and stability are restored through Isometric exercises, progressing to isolation exercises, then compound and dynamic movements.
Patient education on why the Turf Toe Injury was caused and prevention are also an important part of my services. This includes instruction on choosing the proper footwear for a given activity, the importance of ongoing strength training, and the potential benefits of orthotics.
Working in partnership with the patient, Turf Toe can be successfully treated to get the athlete back on the field, playing the sport they love safely.
Make an appointment with Dr. Toothaker or another OSC Physical Therapy provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.