What is Turf Toe?

21 Sep

turf toe diagramTurf Toe is considered a relatively minor sports injury, but it can be quite painful. Known as a Metatarsophalangeal joint sprain in medical jargon, turf toe is basically an injury to the joint and connective tissue between the foot and the big toe.

Most commonly associated with football players who play on artificial turf, it also affects athletes in other sports including soccer, basketball, wrestling, and gymnastics.  Turf  toe is usually the result of jamming the big toe into the ground, bending it backward beyond its normal limits, or repeatedly and forcefully pushing off the big toe as one would do when running or jumping. Many NFL players routinely have their toes taped before games to prevent this injury.

According to Russell Warren, a professor of orthopedics and the team physician for the New York Giants,

“I see it in linemen—particularly the ones on the ends of the line. If that player gets overpowered and his knee is down on the turf and his foot is out behind him, and he falls back on his foot or somebody else falls on it, smashing the toe into the ground and hyperextending it.

“The wrenching motions cause inflammation—swelling and stiffness—of the joint where the toe attaches to the rest of the foot, leading to difficulty moving the toe. We’ll turf toe in football illustrationoften try to reduce the swelling and get movement in the joint back by icing the injury or treating it with ultrasound—which stimulates the tissue and causes increased blood flow to the area to speed healing. If motion around the joint is lost, turf toe can become a chronic problem, sidelining some players for up to a month.

“In extreme cases, players can tear ligaments at the joint between the toe and the foot, sprain the joint or injure cartilage underneath the toe, separating it from the bone—by cracking or splitting it. In rare cases, two little bones on the balls of your feet behind the big toe called sesamoids—which are like little knee caps—can stiffen and begin throbbing or, worst-case scenario, fracture.

“If a player gets turf toe—and we don’t make any protective changes—the chance of him sustaining stress fractures and breaks in his foot increases. To protect against re-aggravating the injury, we’ll get them firmer shoes or put a thin, steel plate in the bottom of the shoe to take some of the flexibility out of the tip of the shoe.

Turf Toe symptoms

You know you have turf toe when there’s pain, swelling, and limited joint movement at the base of one of your big toes. The symptoms usually develop slowly and get worse over time. But if it’s caused by a sudden forceful motion, sometimes a “pop” can be felt and the injury will be immediately painful, with symptoms worsening inside of 24 hours.

Turf Toe treatment

It typically takes two to three weeks for turf toe pain to subside. In order to give your toe time to heal, the foot must be rested and the joint protected from further injury. The basic treatment for turf toe is the simple and reliable R.I.C.E.: Rest,Ice, Compression, and Elevation.  Your podiatrist may recommend an over-the-counter anti-inflammatory/pain reliever such as ibuprofen (Advil) or naproxen sodium (Aleve), and may tape or strap the big toe to the toe aside it, or immobilize the foot in a cast or walking boot.  In severe cases, surgery may be necessary.  Physical therapy may be recommended after immobilization to re-establish range of motion, strength, and conditioning of the injured toe.

One goal of treatment should be to evaluate why the injury occurred and to take steps to keep it from re-occurring. Your podiatrist may recommend wearing shoes with better support to keep the toe joint protected from excessive bending and force, and may also recommend using custom designed orthotics. A physical therapist or a specialist in sports medicine can also work with you on developing training techniques to help reduce the chance of re-injury.

Unfortunately, turf toe often returns and can reduce the long-term function of the big toe joint. Arthritis of the big toe is quite common in those who suffer repeated turf injuries or trauma to the big toe joint.

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