> Turf Toe
What is Turf Toe?
Turf toe is the term
used to describe a sprain in the tendons or ligaments
in the ball of your foot that occurs where your big
toe meets the foot. Turf toe is usually caused by your
toe being bent too far back, or when your toe is jammed
forcibly into the ground. Turf toe can be so painful
that you cannot play sports with it at all. Turf toe
usually damages the joint capsule where the base of
your big toe connects to your longer midfoot bone (first
metatarsal). When your big toe bends too far backward,
the tendons, cartilage, or bone in your big toe’s
joint with your foot (first metatarsophalangeal joint)
can be injured. Your big toe’s joint with your
foot has a complicated structure. Underneath this joint
lies the ball of your foot, which covers two smaller
bones, called the medial and lateral sesamoids. Like
your kneecap, these sesamoid bones act as a kind of
lever to make movement in your big toe more efficient.
Tendons attached to your sesamoids help pull your big
toe downward, enabling you to stand up on your toes
and push off when you start to run or jump. Turf toe
commonly is an injury to the capsule surrounding the
sesamoids or the tendons attached to your sesamoids.
However, each case of turf toe can have different facets,
such as bone, cartilage, or ligament damage throughout
the joint. Turf toe can be classified into three grades
I – Stretching in the joint capsule, tendons,
or ligaments that move your big toe.
II – Partial tears in your big toe’s joint
capsule, tendons, or ligaments.
III – Tears in your big toe’s tendons or
ligaments and possibly damage to the bone and cartilage
surface on the base of your big toe or the end of your
long midfoot bone.
Improper footwear makes an athlete
more susceptible to turf toe. Also, although turf toe
can happen when playing on grass fields, the strong
grip of artificial turf causes the majority of serious
big toe injuries. This risk is enhanced by the fact
that many athletes wear soft-soled tennis shoes that
offer no toe protection when playing on artificial turf.
Football players, especially linemen, most commonly
suffer turf toe. They put a lot of strain on their big
toes when they push off the ground at the line of scrimmage
and often are involved in pile-ups in which other players
may fall on their feet. Though turf toe can occur when
your toe is bent too far in any direction, it commonly
occurs when your big toe is bent upward. The tendons
and ligaments that pull your toe downward are stretched
too far and can tear. Turf toe also can be caused by
overuse, but most people can recall a particular incident
when their big toe was bent too far, or hyperextended.
Severe turf toe injuries that cause cartilage and bone
damage usually are a combination of hyperextension and
compression. For example, your big toe can bend upward
too far while another athlete falls on your foot, which
jams the ends of the bones in your big toe and foot
Athletes who suffer turf toe usually can return to action,
but there is no cure for the condition. Most people
can treat turf toe without surgery, with a combination
of rest, ice, medication, and stiff soled shoe inserts.
You remain at risk for suffering repeated turf toe injuries
and your physician typically prescribes preventive toe
taping when you participate in sports and activities.
More severe turf toe injuries that damage the bones
in your toe may require your foot to be immobilized
for a few weeks. If left untreated, turf toe can cause
bone spurs to develop around the toe joint that may
need to be surgically removed. Removing the spurs can
bring pain relief, but many times this does not address
the cause of the bone spurs, and arthritis can still
result. Surgery rarely is prescribed to treat turf toe
unless you suffer from other complications such as arthritis,
repeat injury, or chronic pain.
There usually are three
parts to an orthopedic evaluation: medical history,
a physical examination, and tests that your doctor may
Your physician likely will ask about your activities,
which may have injured your big toe. You will probably
be asked when the soreness or pain began and if you
recall hyperextending your toe recently. If you have
had any prior turf toe injuries, your physician will
ask about the treatments you have tried in the past.
Physicians also typically ask about other conditions,
such as diabetes and allergies, and medications currently
being taken. You may also be asked about your physical
and athletic goals – information that will help
decide what treatment might be best for you in achieving
can often diagnose turf toe by putting direct pressure
on the ball of your foot, around where your big toe
meets the foot. Your toe is usually tender when pressure
is applied, and pain tends to increase when your toe
is bent upward. Some swelling may be visible around
your toe joint. Your physician also may examine your
gait as you walk around to check for a limp. Turf toe
often makes it difficult to push off with your toes
as you begin to step.
X-rays of your big toe commonly are taken from different
angles so your physician can check for bone damage at
your big toe’s joint with your foot. Small bone
chips may be present in the X-ray that can indicate
compression fractures. Severe cases of turf toe may
have slightly dislocated your big toe, which may be
seen in an X-ray. MRI (magnetic resonance imaging) may
be given when X-rays do not show any bone damage. MRI
may be able to reveal soft tissue damage that is causing