Turf Toe

Orthopaedic & Spine Center

 

Joel D. Stewart, MD

The big toe joint {metatarsophalangeal (MTP) joint at the base of the big toe} can be sprained by jamming or by repetitively springing, pushing off or jumping during sports.  It can also be sprained through accidentally bending it too far backward. We tend to see this injury more among athletes, football players in particular.  After the advent of artificial turf, big toe (MTP) sprains became more and more prevalent, as synthetic turf is harder and doesn’t “give” against an applied force as a natural grass field would.  Hence, the name Turf Toe.  While football injuries are on the decline due to the structural improvements made to athletic footwear, football players, gymnasts, basketball players and weekend warriors are those most likely to be affected by Turf Toe.

To envision how an injury to the MTP joint might happen, think about lining up on the line of scrimmage and the force you would apply to your big toes when pushing off to block an opponent in football.  When we talk about a sprain of the great toe joint, we are over-simplifying the mechanics of a very intricate joint “zone”, which includes bones, ligaments, a tendon and other soft tissues, called the plantar complex. A Turf Toe injury can include damage to any or all of these components and can range in severity from mild to severe.  Mild injuries usually involve over-stretching of the plantar complex, while more serious injuries can involve partial or full tears.

Symptoms of “Turf Toe” are pain, swelling, and bruising.  The athlete may not be able to bend their toe downward or be able to bear any weight on the toe.  In some instances, the joint can dislocate.

I diagnose Turf Toe by taking a medical history and examining the patient’s toe and foot.  I may order x-rays to see if there are any boney abnormalities or if the joint is dislocated.  I will check the alignment of the sesamoid bones, which act like kneecaps for the big toe and which give it power.  If I suspect the patient has a more severe injury, I will order an MRI to help me visualize the extent of the damage to the plantar complex and all soft tissues involved.

If the injury is mild or Grade 1, I will suggest relative rest, activity modification, elevation of the foot above the heart, intermittent icing, and OTC NSAIDs for pain and to reduce inflammation, for about a week. Athletes with this level of injury can expect to return to their sport in just a week.

If the injury is a Grade 2 or partial tear, I may also prescribe a stiff walking boot for around 4-6 weeks to help immobilize the area so it will heal.  Athletes will need to stay off the field for a week or two, depending on their progress.  Return to explosive jumping and running can take longer.

Grade 3 or full tears will require all of the above for at least 6 weeks, but often recuperation takes months.  If the joint is unstable, dislocates or just doesn’t heal, surgery may be required to stabilize the joint and repair severe tears.  An athlete with a Grade 3 injury requiring surgery can expect to be sidelined for up to a year, depending upon their sport, to allow for full recovery.

For Grades 2 and 3, I will also prescribe Physical Therapy to help the athlete achieve full range of motion and to build strength and stability.  Before returning to the field, it’s important that anyone diagnosed with Turf Toe purchase and wear sturdy athletic shoes, with plenty of support and hard soles that don’t allow for an excess bending of the great toe.

Long term management of Turf Toe will require continued stretching and strengthening of the plantar complex for many years to come.  Some athletes complain of continuing pain and stiffness long after their injury has healed.  With a proper regimen of exercise and stretching, along with protection of the injured toe joint, Turf Toe can be well managed, allowing athletes to return to the sports they enjoy playing competitively.

 

Make an appointment with Dr. Stewart or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.  

 

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