Turf Toe

What is turf toe?

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.

What part of my toe does this injury affect?

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.

What are the types of turf toe injuries?

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:

• Grade 1: Typically, the soft tissue in your toe is stretched, but not torn. The area is sensitive when you touch it. It may be mildly swollen. You may have mild limitations with sports and exercise abilities.
• Grade 2: The soft tissue in your toe is partially torn. The area has intense, widespread tenderness and is often swollen and bruised. You’ll be more limited with sports and exercises.
• Grade 3: The soft tissues in your toe are completely torn. Your MTP joint may be dislocated. Swelling and pain in your toe are severe. It’s very difficult to move your toe, let alone exercise or play sports.

How common is turf toe?

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.

What are symptoms of turf toe?

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:

• Pain and tenderness: Pain in your toe may be constant, or it may only hurt when you press on the area. Big toe pain may be so severe that you can’t put weight on it.
• Swelling and bruising: The base of your big toe may be inflamed. Bruising can extend around your swollen toe and up to the top of your foot.
• Limited range of motion: You may not be able to move your toe or bend it up and down. You may feel like your foot is weak or you’re unable to push off the ground like before.
• Joint that feels loose: The metatarsophalangeal (MTP) joint may pop out of place or feel like it’s unstable. The joint may also feel stiff.

What causes turf toe?

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.

Do flip-flops cause turf toe?

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.

What are the complications of turf toe?

Most turf toe injuries heal well, but complications can occur. These can include:

• Persistent pain and joint stiffness.
• Loss of push-off strength.
• Bunions.
• Hallux rigidus.
• Sticking up of your big toe permanently.

How is turf toe diagnosed?

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.

How do you fix a turf toe?

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:

• Rest: Ask your provider how long you should avoid putting weight on your foot. Depending on the severity of the injury, you may need to take a break from sports and activities for several days or weeks. Your provider can give you a walking boot or crutches to use while your toe heals.
• Ice and elevation: Every few hours, relax with your foot above your heart. Apply a cold compress to your toe for about 20 minutes at a time. Ice reduces swelling and pain. Elevating your toe reduces inflammation.
• Over-the-counter (OTC) pain medication: Talk to your provider about taking nonsteroidal anti-inflammatory drugs (NSAIDs). These over-the-counter medications relieve pain and reduce swelling.
• Physical therapy (PT): An experienced physical therapist will give you exercises and stretches to help your toe heal. A customized PT program includes exercises to reduce stiffness, improve flexibility and strengthen muscles that support your MTP joint.
• Stabilization: Ask your provider to show you how to tape your big toe to your smaller toes. This turf toe taping technique restricts motion while your toe heals. When you do return to activities, be sure to wear sturdy, supportive footwear.
• Orthotics: Your provider may recommend special inserts that fit into your shoe or a particular type of shoe, like a stiff-soled or rocker bottom shoe. Orthotics stabilize and support your toe joint while you’re running, jumping or playing sports.
• Surgery: Rarely, a turf toe injury requires surgery to repair severe tears, fractures or joint damage. The type of surgery depends on the injury’s location and which bones and soft tissues have the damage.

How long does a turf toe take to heal?

The length of time a turf toe injury takes to heal can vary based on many factors, including:

• The grade or severity of your injury.
• Your age and activity level.
• Other health conditions.

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.

Can I prevent turf toe?

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.

What is the outlook for people with turf toe?

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.

What happens to untreated turf toe?

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.

When should I see my healthcare provider about turf toe?

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.