Turf toe is an injury in your big toe joint when ligaments, tendons and soft tissues in the joint stretch or tear. It’s a common injury among football players and athletes who sprint or jump. Turf toe usually gets better with rest, ice and over-the-counter pain relievers. Severe turf toe injuries may need surgery.
Turf toe, or a metatarsophalangeal joint sprain, is an injury that affects your big toe joint. It happens when your toe remains on the ground and your heel lifts, causing your toe to hyperextend. This motion causes soft tissues and ligaments in your big toe joint to stretch or tear (toe sprain).
Turf toe is common among American football players because they frequently push off their toes into a sprint or make sudden movements while running on turf, which is less forgiving than grass. Most of the time, the injury gets better with treatments like rest, ice and medications like ibuprofen or acetaminophen. Some sprained toe injuries that don’t heal with these treatments may need surgical repair, but this is much rarer.
Your big toe has two joints. The larger joint is called the metatarsophalangeal joint (MTP joint). This joint connects the base of your big toe to the rest of your foot.
Tendons, ligaments and connective tissue hold the bones and muscles of your big toe together. These structures provide stability and allow your big toe to move without dislocating. A turf toe injury can range from simple sprains to dislocations of your MTP joint.
Healthcare providers use a grading system to classify turf toe injuries. The grade helps determine the most effective treatment plan. The types of turf toe injuries are:
Turf toe is commonly associated with athletes competing on a turf surface, but it can happen to anyone. The injury can occur in various sports and activities on turf or flat surfaces. It can also occur whether you’re wearing flexible or rigid shoe wear.
Turf toe injuries increased in the 1970s when football players began playing on artificial turf instead of grass. Artificial turf is a harder surface than natural grass. The use of flexible, lighter shoes may contribute to this increase, as well. This also may be related to changes in the interaction of the surface with the shoe wear.
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Turf toe symptoms range from mild to severe. If a sudden injury caused turf toe, you may have heard or felt a “pop” when the injury happened. Pain in your toe from a sudden injury usually comes on right away.
Turf toe symptoms from repetitive injuries usually appear gradually and get worse over time. Symptoms of turf toe include:
A turf toe injury happens when your big toe is bent and pressed flat against the ground. Usually, your heel is high off the ground, like a sprinter’s starting position. If you put too much force on your big toe, you can hyperextend it (bend it farther than it’s supposed to go). Bending your toe beyond its natural range of motion can cause ligaments, tendons and soft tissues in the joint to stretch or tear.
Turf toe can result from many repetitive movements over time (like a ballet dancer’s jumps). The injury can also result from sudden trauma, like when a football player tackles an opponent whose toe is planted on the ground. Athletes who make sudden foot movements and changes in direction are more likely to get this type of injury.
While many turf toe injuries are sports-related, they can also occur due to your choice of footwear. Most flip-flops aren’t supportive. They fit loosely, which makes your feet have to work harder to keep them on. You may not experience symptoms right away, but wearing flip-flops can eventually cause foot problems, including turf toe.
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Most turf toe injuries heal well, but complications can occur. These can include:
Your healthcare provider will examine your toe and gently push on the area to check for tenderness. They may ask you to move your toe to test your range of motion. If you had a sudden injury, your provider will ask you how it happened. Be sure to share as many details as you can remember, including how your toe was planted and where you felt pain.
To check for damage in your bones and soft tissues, your provider will order an X-ray and if needed, an MRI (magnetic resonance imaging) scan. These tests produce images of bones, ligaments, tendons and soft tissues.
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Most sprained toe injuries heal with time and plenty of rest. Grades 1 and 2 turf toe injuries usually get better with conservative treatments that you can do at home. Your provider may recommend turf toe treatment, including:
The length of time a turf toe injury takes to heal can vary based on many factors, including:
With rest, a grade 1 turf toe injury could clear up on its own within a week. A grade 2 injury could go away within two to three weeks. A grade 3 injury may take two to six months to heal. If you’ve had surgery, your recovery time will be longer.
You may not always be able to prevent turf toe, especially when it results from an accident. To reduce your risk of turf toe, wear shoes that provide enough stability for your activity. Football and soccer players should avoid shoes that are too flexible, especially in the toe area.
Before an activity or sport, take time to stretch and warm up. When muscles and soft tissues are warm, they’re less likely to get injured. If you play sports (like football, gymnastics or ballet) that increase your risk of turf toe, talk to your provider. A physical therapist can help you lower your chances of injury.
Many people with turf toe don’t have long-term problems after recovering from the injury. Some people continue to have joint stiffness, weakness or big toe pain (hallux rigidus). Rarely, your big toe sticks up from the others and doesn’t lie flat on the floor when standing.
If you don’t treat turf toe, it can lead to extreme pain and long-term stiffness in the joint. In addition, you could lose your ability to jump or run. Severe cases can cause arthritis and bone spurs to develop around the joint or dislocation.
Call your healthcare provider if you have pain, swelling or bruising in your toe or foot. Even if the pain is mild, it’s important to get evaluated so your provider can recommend the right treatment plan. See your provider right away if the pain is severe, you can’t put weight on your foot or the toe joint looks dislocated.
A note from Cleveland Clinic
A turf toe injury can put you on the sidelines for days or weeks. But with self-care and proper treatment, turf toe injuries usually heal without long-term problems. It’s essential to follow your physical therapist’s instructions and give your body plenty of time to heal. If you feel pain in your big toe during sports or activities, take a break. Never ignore pain or try to push through it — doing so can make an injury worse. See your provider for an evaluation so you can get back in the game as soon as possible.
Last reviewed on 02/06/2024.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy