What is turf toe?
Turf toe is a sprain of the metatarsophalangeal (MTP) joint in the big toe. This type of injury was dubbed turf toe in the 1970s due to the prevalence of the injury in football when playing on artificial turf.
The MTP joint connects the first metatarsal bone from the foot with the first phalanx bone of the big toe. The big toe's plantar complex includes ligaments, the flexor hallucis brevis tendon, two small sesamoid bones, and the fibrous plantar plate tissue. The MTP joint is critical for walking, running, and jumping.
A sprain can occur when the ligaments or tendon in the big toe stretch too far or too forcefully (such as in a toe hyperextension). Sudden push-off movements and continued cutting and change of direction can lead to turf toe. This painful injury generally requires rest to recover, but severe cases may need surgical repair.
Grades of turf toe
A turf toe injury has three grades. The severity of the stretching or tearing of the soft tissue will often dictate the treatment path and recovery time.
- Grade 1: A minor stretch of the soft tissue within the plantar complex may lead to minor swelling or pain, with only some limitations on mobility
- Grade 2: A moderate stretch and partial tearing of the plantar complex will limit mobility and typically manifest in additional pain and swelling
- Grade 3: A full tear of soft tissue makes mobility difficult, increases pain, swelling, and tenderness, requiring additional time—and sometimes surgery—for recovery
What are turf toe symptoms?
Pain and swelling are the most common symptoms of turf toe. If stretching occurs over time, symptoms may steadily grow more intense. Typically, if the injury occurs suddenly—sometimes a pop is heard or felt—the pain starts immediately and increases over the next day.
Common turf toe symptoms include:
- Pain radiating from where the big toe meets the foot
- Tenderness to the touch
- Swelling and bruising at the injury location
- Limited mobility and range of motion due to a weakness of the big toe
- Difficulty bending the big toe in a downward motion and a general feeling of stiffness
- Loose joints, which can be a sign of dislocation
What are risk factors and causes of turf toe?
A turf toe injury happens when the big toe bends beyond its typical range of motion. A planted toe and a raised heel can put too much force on the toe, stretching the soft tissue within the metatarsophalangeal joint. In some cases, the toe gets stuck on the ground. In other instances, the force from a hit (such as a tackle in football) stretches the toe too far.
Any sport with frequent toe-offs, sudden direction changes, and physical contact can increase the risk of a turf toe injury. While turf toe can happen on any surface, a combination of a hard surface and flexible footwear increases the risk of injury.
How is turf toe diagnosed?
To diagnose turf toe, your doctor will conduct a physical examination and may order imaging scans. A physical exam often includes:
- Questions about any injuries or painful activities and the extent and location of the pain in the toe
- Movement testing to evaluate pain, range of motion, and stability or weakness of the big toe
- An investigation of the tenderness, swelling, and bruising of the big toe
An X-ray can show if the bones in the plantar complex are injured. A magnetic resonance imaging (MRI) scan will show the extent of the damage to soft tissue, including ligaments and tendons. An MRI can distinguish between a partial and full tear for turf toe.
Request an appointment with a Mass General Brigham sports medicine specialist to learn more.
Turf toe treatment
Treatment for turf toe typically starts with rest to reduce swelling and pain.
When treating turf toe, the RICE protocol—rest, ice, compression, and elevation—helps minimize additional stress on the joint. Anti-inflammatory drugs may help reduce swelling. In more serious turf toe injuries, a boot can immobilize the toe. The more severe the injury, the longer the need for immobilization. Following immobilization and rest, physical therapy may be needed to strengthen and stretch the muscles in and around the big toe.
When immobilization isn't enough to correct a serious turf toe Grade 3 injury, especially one that involves dislocation, surgery may be the best option for repair. Turf toe surgery isn't common.
With proper rest, a mild case of turf toe may resolve within two to three weeks. The more severe the injury, the longer the need to immobilize and rest the toe. Recovery from a Grade 3 turf toe injury could take two to six months, depending on if surgery is required.
How to prevent turf toe
Wearing proper footwear can provide stability for the toe and foot. Football and soccer players should wear shoes that provide stability in the forefoot. A proper warm-up before athletic activity can also help soft tissue prepare for movement and reduce the risk of turf toe.
FAQs
Turf toe almost always goes away with proper treatment, such as rest and ice.
Turf toe is a sprain of the big toe's soft tissue, so an X-ray will not show the damage.
The best treatment for turf toe is rest and ice. Epsom salt may temporarily relieve pain but does not provide lasting help.
Surgery for turf toe is typically only needed to repair full tears of the soft tissue within the metatarsophalangeal joint or when the bone has dislocated.
