Turf Toe

Turf toe

Turf toe is a sprain of the joint at the base of the big toe. It is caused by a very vigorous upward bending of the toe.

Medically reviewed by Dr. Chaminda Goonetilleke, 20th Jan. 2022

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Turf toe symptoms

Symptoms of Turf toe include:

  • Pain and swelling at the base of the big toe.
  • You will feel pain and tenderness bending your big toe upwards.
  • It will feel tender when pressing in under the ball of your foot.

It is important to compare your injured foot with the uninjured one. Your doctor may use an X-ray or MRI scan to confirm the diagnosis and check you do not have a fracture. However, this is not usually necessary.

Other potential causes

If the pain in the joint at the base of the big toe (MTP joint) comes and goes, lasting for around at a week at a time, with no obvious cause then consider gout as a possible cause of your toe pain. Gout is a form of arthritis caused by a build-up of uric acid within the body and is more common in men aged 40-60.

A broken toe may have similar symptoms to a severe turf toe injury.

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What is turf toe?

Turf toe is simply a sprain to the ligament at the base of the big toe or great toe. A sprain is a tear or overstretching of a ligament.

Turf toe

Anatomy

The forefoot is made up of the long metatarsal bones which connect to the phalanges bones (toes). The point where the metatarsals attach to the phalanges is called the metatarsophalangeal joint or MTP joint for short. The bones are joined together by ligaments. Ligaments are short bands of tough, fibrous connective tissue.

Causes

Turf toe ligament sprains are caused by vigorous upwards bending of the toe. This occurs when your shoe grips hard on the surface and sticks. As a result, your bodyweight goes forwards, therefore forcing the toe upwards.

When the toe is bent/forced upwards this stretches the ligaments under the toe. As a result, they can become overstretched or torn. Occasionally the surfaces of the bones at the joint can become damaged as well.

It is common in team sports which are played on artificial, grippy surfaces, for example, hockey. It is also more common in martial arts where you need to make fast, explosive movements in bare feet.

You are more at risk if you have increased range of motion in your ankle. Or, if you wear soft flexible shoes which fail to give enough support to your forefoot.

Turf toe treatment

Treatment for turf toe is based on applying immediate first aid PRICE principles (protection, rest, ice, compression, and elevation). Then gradually returning to full fitness as pain allows.

Protection

Protect your foot from further injury by stopping playing or training immediately. Rest completely until you have no pain on normal daily activities.

Wear a brace to protect the toe. Or at the very least wear a shoe that has a firm sole that will not allow your toes to bend.

Taping

Turf toe taping

A turf toe taping technique supports and protects your toe, preventing it from bending. Taping also helps protect the ligament as you return to full training.

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This is especially important if the ligament has been overstretched causing joint laxity.

Cold therapy

Apply ice or cold therapy to the area as soon as possible. This reduces pain and inflammation, speeding up the healing process.

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Cold therapy

Rest

Rest is very important. You may need to use crutches to take the weight off the toe. It is difficult to rest your foot when you need to walk on it. But without rest, it will take much longer to heal.

Compression

Apply a compression bandage to help support and protect your toe. This also helps swelling. The sooner you apply compression, the earlier it will prevent swelling. However, you should only apply a tight compression bandage for 10 minutes at a time. This is because it may restrict blood flow to tissues, resulting in further tissue damage.

Electrotherapy

Your physio may use ultrasound or other electrotherapy treatment to help reduce pain and swelling in the joint.

Exercises

General foot and toe exercises may be required to strengthen your injured foot. This may depend on how long you have been non-weight-bearing.

How long will it take to heal?

Recovery can take three to four weeks depending on how bad the sprain is. After 2 to 4 days you may be able to weight bear again, but pain should always be the guide.

If you do not look after this injury then it may develop complications such as hallux limitus/hallux rigidus. This is a very stiff joint with a decreased range of motion due to arthritis around the joint. As a result, you are more likely to have other problems in the rest of the foot or lower limb. This is due to changes to your natural walking cycle (gait).

References & further reading

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