Key Points about Turf Toe

  • Turf toe is a strain that occurs when the big toe is hyperextended up toward the front of the foot.
  • Turf toe is graded from a mild injury that is associated with minor pain (Grade 1) to a complete tear (Grade 3) that is associated with severe pain.
  • Symptoms of turf toe include pain, stiffness, swelling in the big toe in addition to a popping sensation when the injury occurs, and reduced ability to move the big toe.
  • Turf toe can be diagnosed with a medical history, review of symptoms, activities that caused your symptoms, a physical exam, and diagnostic imaging.
  • Your doctor will develop a treatment plan based on the severity of your injury. While most cases can be treated with rest, physical therapy, and other nonsurgical therapies, in rare cases, you may need surgical intervention to return to your previous activity level.
  • Seek immediate treatment if you have severe pain in the toe joint that is likely turf toe. Early intervention is a key component of a successful recovery.
  • It can take as long as six months for turf toe to heal completely.

Overview

Turf toe is a big toe sprain that occurs when the big toe is hyperextended upward. This can occur as a person pushes off an artificial surface, and the big toe remains flat on the ground. Artificial turf does not provide as much give when force is placed on it, therefore making it a harder surface to play on.

While turf toe is a common football injury, it can also affect people who play a variety of other sports or perform other activities.

There are three grades of turf toe from Grade 1 - Grade 3.

  • Grade 1 — A minor injury that involves tenderness and slight swelling in the affected area.
  • Grade 2 — A moderate injury that involves more severe swelling, bruising, and swelling. Toe movement is painful and limited.
  • Grade 3 — A complete tear that causes severe pain, swelling, and bruising. Patients with a Grade 3 tear may not be able to move their big toe and experience severe pain.

Turf toe causes

Turf toe can develop if your big toe is forcefully bent up toward the front of the foot. When this occurs, your ligaments may stretch or tear as they are forced beyond their normal limits.

Causes include:

  • Participating in sports on artificial turf.
  • Wearing athletic shoes that are do not provide adequate support when playing on turf.
  • Wearing high heels.
  • Participating in activities that put weight on the big toe.

Turf toe symptoms

The most common symptom of turf toe is pain that intensifies when you extend your big toe or put pressure on it.

Other symptoms of turf toe include:

  • Popping sensation when the injury occurs.
  • Swelling or stiffness in the big toe.
  • Inability or reduced ability to move the big toe.

Your pain level will vary depending upon how you damaged your toe. If you suffered turf toe from a forceful movement, your symptoms may be severe and develop immediately. In other instances, your symptoms may be mild and worsen as you put repeated strain on the injury.

Turf toe complications

If not treated early enough or treated effectively, you could experience long-term stiffness and pain in your toe joint. Physical therapy can help relieve pain and aid in stretching the affected area.

Turf toe risk factors

There are a variety of factors that increase your risk of developing turf toe, including:

  • Participating in sports such as football, basketball, soccer, field hockey, dance, and lacrosse.
  • Participating in activities on an artificial surface.
  • Wearing shoes that do not adequately support your foot.

Turf toe prevention

Turf toe can be prevented in many cases. Guidelines to follow to avoid turf toe include:

  • Improve and maintain overall fitness as well as foot and toe joint strength and flexibility.
  • Wear appropriate shoes for the surface you are playing or working on.
  • Ensure your shoes and socks fit correctly.
  • Properly prepare for the surface you are playing on as well as for the sport you are playing.

Turf toe diagnosis

Your doctor can diagnose turf toe. During a clinic visit, your doctor will evaluate when and how the injury occurred, as well as what types of movements or activities make your symptoms worse. Your doctor will also perform a physical exam and order diagnostic imaging, such as an X-Ray or MRI scan.

An X-ray can identify a bone fracture or break.

Turf toe treatment

Treatment will vary depending upon what grade turf toe you were diagnosed with.

Grade 1 turf toe treatment options include:

  • It is essential to rest the toe as instructed by your provider. Resuming your activities too early can worsen the sprain and extend the recovery time.
  • Ice the area as many as three times daily for 20 minutes for three days.
  • Use compression sleeves or stockings, to help promote healing for the three days after injury.
  • Elevate the affected toe as long as possible for up to 72 hours following the injury.
  • Nonsteroidal anti-inflammatory medications help reduce pain and swelling.
  • In some cases, you may be instructed to reduce the movement of the big toe using a boot.
  • Exercises to improve range of motion. Cycling or gentle activities that do not move the toe joint can help the recovery process. Typically, you will be instructed to wait approximately five days before trying any gentle exercises.

Grade 2 cases of turf toe can be treated with the following therapies:

  • Avoid sports activity for as long as 14 days after the injury.
  • Wear turf toe plate or Morton’s extension.
  • Immobilize the joint using a walking boot.
  • Gradual exercises to improve range of motion.

Grade 3 cases of turf toe can be treated with:

  • If you have a turf toe that is classified as Grade 3, you may need to be in a walking boot or crutches for as long as three weeks.
  • Physical therapy. You will be advised to start physical therapy soon after the injury to prevent stiffness and strengthen the joint.
  • You will be advised to take an extended break from your sport. Symptoms could persist for as long as six months.

In rare cases, surgery is necessary to treat turf toe. You may be a candidate for surgery for turf toe in the following circumstances:

  • Tear in the plantar area.
  • Damage to cartilage in joint.
  • Develop a bunion.

The goal of surgery is to repair the tissues and restore joint motion so you can return to your activities as quickly as possible.

When to Seek Care

Schedule a visit with your doctor if your pain is impacting your ability to perform daily tasks.

Other reasons to schedule an appointment include:

  • Your toe is deformed.
  • You are experiencing severe pain, swelling, or change in skin or toenail color.
  • Your big toe and surrounding areas are tender to touch.

Next Steps

If you are in severe pain, seek immediate treatment. Early intervention is essential to successfully treating turf toe and speeding up the recovery process.

Carefully follow your doctor's treatment and recovery instructions. You may need follow-up tests or X-rays to ensure you are fully healed before returning to play.

When recommended, wear toe inserts to prevent the big toe from bending backward.

It could take as long as six months to recover from a turf toe injury.