Turf toe is a hyperextension injury of the big toe. Hyperextension follows excessive axial force applied to the end of the toe, usually when the athlete is flexed at the ball of the foot. For example, linemen in football are normally positioned in a “three-point stance’, with the feet flexed, and the heels off the ground. When the player accelerates forward, the flexion of the foot is increased, which may cause injury to the joint capsule of the base of the big toe (the first metatarsal-phalangeal joint). The stretching or tearing of the joint capsule causes severe pain, and can lead to instability of the joint. Symptoms can persist in the long term, and permanent decrease in joint function can result if the injury is not rested/treated properly.
Why has turf toe increased in incidence?
Synthetic turf playing surfaces - Turf toe was virtually unknown until the 1960s, when artificial turf was introduced. Early surfaces were far firmer than natural grass fields, increasing the force on the feet during play.
Changes in athletic shoe technology – As athletes looked for better performance from footwear, shoes were made more with flexibility and better traction. These factors serve to increase the forces on the foot.
Severity of Turf Toe
Turf toe injuries are classified into three groups, based on severity of the injury:
Grade I: Stretch injury to the joint capsule, with minimal tearing.
Grade II: Partial tear of the capsule and surrounding ligaments
Grade III: Complete tear of the capsule and ligaments, with associated bone bruising.
Diagnosis of Turf Toe
Turf toe is usually diagnosed by physical examination. X-rays are usually obtained, to evaluate for possible associated fracture of the toe. MRI may be helpful if there has been a complete ligament tear, but is generally not performed except in unusual cases.
Treatment of Turf Toe
Grade I injuries: Measures are taken to decrease movement of the great toe, to allow for healing of the joint capsule. The great toe may be taped to the adjacent toes to decrease movement. Firm shoes with stiff insoles may be prescribed to decrease foot flexion. Athletes with grade I injury can return to play immediately, if the pain is tolerable.
Grade II injuries: Grade II injuries are treated like grade I injuries, with the exception of a prescribed period of inactivity. Athletes with grade II injuries should refrain from sports participation from 3-14 days, depending on symptoms.
Grade III injuries: Grade III injuries are treated with immobilization and rest for 2-6 weeks. Injuries that fail to heal with rest may ultimately require surgery.
For more information, see “Turf Toe”, at emedicine.com.
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