What is Turf Toe?

Turf toe refers to an injury involving excessive hyperextension (upward bend) of the big toe. The injury occurs at the 1st metatarsophalangeal (MTP) joint, where your big toe joins the long metatarsal bone. Damage to this area can involve any or all of the multiple structures surrounding this joint. These include:
  • Flexor hallucis brevis tendon – This runs under the first metatarsal and attaches the base of your big toe
  • Sesamoids – Two small bones which are below your MTP joint and provide increased stability while walking. These bones are contained within the flexor hallux brevis tendon
  • Plantar plate – This fibrous band of tissue runs underneath the toes and prevents excessive extension
  • Collateral ligaments – These surround the MTP joint on either side and prevent excessive sideward movement

Signs and Symptoms

The most common signs and symptoms of a turf toe injury are dependent on the severity of the injury:Grade 1 Injury – Overstretching of the structures around the MTP joint
  • Pin-point tenderness
  • Mild swelling
  • The area may be red
  • Ability to continue activity but with discomfort
Grade 2 Injury – Partial tearing of the structures around the MTP joint
  • Increased tenderness
  • Increased swelling
  • Moderate bruising
  • Pain elicited on movement of the toe
  • Inability to weight bear on the toe
  • Symptoms of a grade 2 injury will also increase over the initial 24 hours
Grade 3 Injury – Complete tear of the structures around the MTP joint
  • Severe tenderness
  • Severe bruising
  • Severe swelling
  • Difficult and painful to move the big toe yourself
  • This type of injury is also often associated with disruption of the plantar plate, or fractures of the sesamoids.

Causes of Turf Toe

Turf toe usually occurs in sporting athletes. The use of the term “turf” refers to the increase in the injury alongside the introduction of artificial turf to American football. Despite this, the injury can occur to players of any sport. The hyperextension injury can be the result of jamming the toe into this position, or it may be a result of repeated extension over time.Footwear can also be a contributing factor. If your sport shoes’ sole is not adequately stiff, this may increase your risk of hyperextending your big toe during activity. High-heeled shoes may also contribute over time to a turf toe injury.

Diagnosis of Turf Toe

To diagnose turf toe, our team at OnePointHealth will perform a detailed examination of your toe and foot. An assessment of your range of movement, the severity of the pain, and the history of the injury will allow us to determine the nature and extent of your injury.If a higher grade injury is suspected, X-ray or MRI imaging may be used to further assess the severity of the injury, including the surrounding structures.

Conservative Treatment

Initial treatment of turf toe is the same as for all soft-tissue sporting injuries:RICE
  • Rest – Modify activities that aggravate pain
  • Ice
  • Compression – An elastic compression bandage will help reduce swelling and inflammation
  • Elevation – Keep your leg elevated higher than your heart to reduce swelling
  • Following a consultation, we will recommend a treatment plan based on the severity of your injury and your individual circumstances.
Grade 1
  • RICE
  • Use of a stiff insert into the shoe to stabilise the toe
  • Toe strapping to stabilise the toe
Grade 2
  • An immobilisation boot may be required to reduce initial weightbearing
  • Immobilisation usually lasts one week, after which a taping program is used to stablise your toe while it heals.
  • Grade 2 injuries usually require 3-14 days of recovery before a return to activity
Grade 3
  • These types of injuries may require several weeks of immobilisation.
  • For all grades of injury, mobilisation is an important part of recovery. Once the initial immobilisation phase is complete and symptoms have reduced, a rehabilitation program will be implemented to ensure your toe does not become stiffened.

Surgery for Turf Toe

Surgery is usually not necessary to treat turf toe. However in cases that are non-responsive to conservative treatment, surgical intervention may be required.