Turf Toe

Turf Toe Description
turf toeTurf Toe is a hyperextension injury to the great toe (big toe). Turf toe can occur when something heavy lands on the heel when the big toe is already flexed. This occurs typically when a player lands on the back of another player’s foot. This can tear the tissues that hold the bottom of the toe together. Turf toe can occur from repetitive extension of the big toe as well. Repetitive injuries can occur in sprinters from repetitive sprint starts, football lineman and can occur with cyclists who use improper shoes or pedals.

Turf Toe Anatomy
Turf Toe is

Turf Toe Symptoms
Turf Toe causes pain and swelling in the big toe. Turf toe commonly causes pain with walking or running and decreased push off strength. The pain is located in the great toe metatarsalphalangeal joint. The pain is generally worse on the bottom of the toe at its base. There may be bruising and swelling as well.

Turf Toe Treatment Turf Toe is diagnosed based on a detailed history, physical exam and xrays performed by an orthopaedic surgeon, or sports medicine specialist. Initial treatment for Turf Toe depends on the grade of injury.  

Grade I Turf Toe injuries are mild and usually respond well to taping and early rehab exercises such as range-of-motion exercises and gradual strengthening. Initially,  rest, icing, compression and elevation (RICE) is beneficial.Most athletes are able to return to play as tolerated. Occasionally a turf-toe plate or carbon-fiber orthosis is used to limit extension of the big toe.

Grade II Turf Toe injuries are moderate and represent partial tears. Grade II injuries typically cause moderate swelling, and restricted motion due to pain. Grade II Turf toe injuries are generally treated with taping and early rehabilitation (eg, range-of-motion exercises, gradual strengthening). Initially, rest, ice, compression and elevation (RICE) is beneficial. Stiff soled or rocker bottom shoes may also be helpful. Return to play generally takes 2-3 weeks. Occasionally a turf-toe plate or carbon-fiber orthosis is used to limit extension of the big toe.

Grade III Turf Toe injuries are severe and result from complete disruption of the plantar structures of the great toe. This causes significant swelling, bruising and weakness in flexing the big doe. Grade III Turf Toe injuries are typically treated with immobilization in plantar flexion to allow the plantar structures to oppose and heal. It generally takes 4-6 weeks to return to play after a Grade III Turf Toe injury. More severe injuries may take even longer. Surgical repair is occasionally needed for severe injuries in high level athletes.  

Athletes returning to sports after Turf Toe should begin with a graduated exercise program with the great toe protected with taping, a turf-toe plate or carbon-fiber orthosis. First they should be pain free with daily activities with full range of motion and at least 85% strength in the injured extremity compared to the uninjured extremity.  Exercise begins with light jogging in a  straight line, followed by sprinting in a straight line. When these have been done without pain the athlete can proceed to doing agility type drills such as 45º cuts, 90º cuts and jumping. Agility drills should begin at half-speed and proceed to full-speed provided the athlete remains pain free.

Turf Toe Prevention
Prevention of Turf Toe is limited. Wearing proper sized shoes with firm soles is beneficial. Recurrent injury is very common.Taping the big toe, a turf-toe plate or carbon-fiber orthosis to prevent motion can help decrease the risk of recurrent injury. Maintaining aerobic conditioning, foot and ankle flexibility and muscle strength is always important.

Turf Toe Risk Factors
Turf Toe is associated the following sports: Baseball; Basketball; Cycling; Dance; Football; Gymnastics: Rugby; Running; Soccer; Tennis; Volleyball; Wrestling. It is more common in athletes who play on artificial turf fields, but can occur under any playing condition.  People with long bit toe or flat feet may be at increased risk of turf toe.

Turf Toe Rehab and Exercise Program
Ankle Flexion

Ankle Extension
Ankle Proprioception

Towel Curls

Toe Flexion/Extension

Turf Toe Outcomes
Turf Toe generally resolves with conservative treatment without long term symptoms.  Recurrent episodes of turf toe can lead to arthritis and hallux rigidus.

Similar injuries that can be confused with Turf Toe include:
Sesamoid fracture

bipartite sesamoid

hallux valgus

hallux rigidus

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