Turf toe is a term used to describe a sprain of the ligaments surrounding the joint of the big toe.
This type of injury is typically had when the toe bends into a hyper-extended position, which occurs most frequently from the ‘pushing-off’ position seen in runners pushing off the block into a sprint, and in American football players at the start of play. It is not the pushing off that causes injury but the jamming of the big toe into the ground or forcefully and repeatedly pushing of from the toe over a long period of time.
Because this injury is particularly prevalent in American football players—especially after artificial turf replaces real grass—it garnered the nickname ‘turf toe’. The problem with artificial turf is that it’s a much harder surface than grass and it is much less shock absorbent, which means that the forceful energy generated by this movement is often reabsorbed by the athlete—and their big toe.
While joint sprains of the big toe are most often associated with American football this type of injury can be sustained while participating in a wide variety of sports and activities.
Anatomy of the Big Toe
The big toe is comprised of two joints, the larger of the two being the metatarsophalangeal joint, or MTP. This joint is found where the first long bone found on the inside of the foot (the metatarsal) connects to the first bone of the toe (the phalanx).
Turf toe refers to injury of the metatarsophalangeal (MTP) joint, which connects the metatarsal of the big toe to the phalanx of the big toe. This particular joint is surrounded by a complex structure that stabilizes the joint and is meant to prevent dislocations from occurring. This structure is referred to as the plantar complex and is made up of the following components:
Turf toe typically refers to a sprain of the ligaments surrounding the big toe but includes an injury of any soft tissues in the plantar complex, including the flexor hallucis brevis or a collateral ligament.
Turf toe injuries vary in severity. Injury is said to occur when there is excessive stretching of the soft tissues, partial tearing of the soft tissue, and/or complete dislocation of the MTP joint. Doctors grade the injuries on a scale of 1 to 3; one being the mildest level of injury and three being the most severe. Not only does this make it easy to quickly communicate the severity of the injury but it helps them outline treatment options.
Injury levels are defined thusly:
Turf toe is a risk in any sport or recreational activity that demands the forefoot be flexed with the heel raised in preparation for a ‘push-off’, the force of which pushes the big toe into hyperextension.
As previously noted, this injury occurs most frequently among American football players who routinely play on artificial grass, or ‘field turf’. Because artificial surfaces have a tendency to be much firmer and less shock absorbent these athletes use specially designed athletic footwear to compensate for the harshness of playing on such an unforgiving surface. Problems still occur however; because the shoe is softer and more flexible (allowing for greater agility) it absorbs more of the force of impact but provides much less stability in the forefoot.
The RICE protocol is often the first form of treatment provided for sports-related injuries and is typically applied within minutes of the injury occurring. RICE is an acronym for Rest, Ice, Compression, and Elevation, and is usually applied in the following ways:
Over-the-counter non-steroidal anti-inflammatory medications such as ibuprofen or aspirin are often used to relieve inflammation and the discomfort associated with inflammation.
If the injury is severe or symptoms persist or worsen the best thing to do is cease self-treatment and seek medical attention. Be ready to explain the cause of the injury, provide a detailed description of your symptoms, and advise your doctor of the treatment methods you have been using. The more information you give your doctor the more accurately he or she will be able to treat you.
Should you find yourself in your doctor’s office seeking treatment you will probably discuss your general health and the specific symptoms and nature of your injury.
The next part of the examination will be physical. Your doctor will examine your foot for signs of swelling, bruising, and the degree of motion in your MTP (metatarsophalangeal) joint. This part of the examination may be uncomfortable as your doctor will have to grasp the injured digit and bend it up and down as well as side to side. This will reveal any instability in the plantar complex, which indicates that there may be a tear in one or more of the tissue.
A range of motion test may be performed on the uninjured toe in order to compare the two. Your doctor will bend your toe up, move it up and down, and side to side, looking for instability that might suggest a tear in the plantar complex. He or she may also perform the same range of motion tests on your healthy toe as a comparison.
Because the range of motion tests may be painful your doctor may suggest an injection to help numb the general area of the toe that is injured. This should greatly reduce the degree of discomfort that can occur during the examination.
Diagnostic Imaging Tests
Your doctor may order tests to help confirm the exact nature and degree of your injury. It will likely be an x-ray or an MRI scan that is performed. Here is what you can expect from this type of procedure:
X-Rays: An x-ray is a medical image that performs best on dense, hard structures—bones being a prime example. An x-ray creates a clear picture of the bones inside your foot. This allows your doctor to see if there are any other problems with the toes, such as smaller, multiple fractures that may occur at the point where the plantar complex attaches to the bone as well as any damage that may have been done to the sesamoid bones in that area.
Magnetic Resonance Imaging (MRI) Scan: MRI`s are particularly adept at creating high quality images of the soft tissue within the body. Any injury sustained by cartilage tissues will be revealed in this type of image. An MRI may be used if an x-ray scan revealed abnormalities of the foot or toe, or when the injury has already been identified as a Grade 2 or Grade 3 injury.
Conservative Treatments for Turf Toe
The grade of the injury will determine the course of recommended treatment. It`s worth noting that surgery is not the primary treatment option in the majority of cases. Here are some of the most common conservative treatment methods used to treat turf toe according to the grade of the injury:
Grade 3: When a turf toe injury is given a Grade 3 status it indicates that the injuries severe. They are also initially treated quite differently from Grade 1 and 2 level injuries:
Surgery is rarely if ever necessary in the treatment of turf toe as conservative methods are usually sufficient. There are exceptions, however; if the level of athletic play continues to be negatively affected or symptoms persist over an unusually long period of time surgical intervention may be recommended. A surgical recommendation is typically prescribed exclusively for severe Grade 3 injuries, such as the following:
The exact surgical procedure used will depend on the nature of the injury. The aim of the surgery is soft tissue repair and restoration of MTP joint movement so that normal use of the great toe can be both restored and preserved.
Orthotics can can take pressure off the 1st metatarsal.
Dr Foot Pro Hallux Rigidus Insoles have a 4 degree forefoot 1st metatarsal post to redistrubtre pressure away from the 1st metatarsal joint, only use these insoles if you have been diagnosed with Hallux Rigidus or Turf Toe.
Long-term outcomes depend on the type of injury and level of intervention; injuries that are immediately addressed usually heal very well and have the least complications. Long-term complications that often develop with turf toe include reduced or minimal push-off strength, a ‘cocking-up’ of the great toe during push-off, and bunion development that interferes with the level of play.
Mild to moderate symptoms such as joint pain and stiffness may persist over time and are the most frequent complication when it comes to this type of injury. Turf toe is not considered a major injury but nonetheless should be addressed early on in order to promote the best outcomes possible.
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