Turf Toe

Turf Toe is a common injury that occurs in football, soccer, basketball and running. It is called Turf Toe since this injury most often occurs when playing on a turf field.  Turf Toe is a sprain of the main joint between the big toe and the mid foot. A sprain is stretching or tearing of the ligaments that support the toe.  This occurs when the big toe is forcefully bent back, or into hyperextension, such as in pushing off into a sprint and having the toe get stuck on the ground. Turf Toe can also be caused by stopping suddenly when running, causing your big toe to slide up into the end of your shoe.  Another mechanism of injury is standing on the balls of your feet as someone falls onto you causing your big toe to hyperextend.

Signs and Symptoms of Turf Toe

The severity of Turf Toe is based on a grading of 1-3, 1 being the least severe and 3 being the most severe. In grade 1 Turf Toe the ligaments and surrounding soft tissue in the big toe have become stretched causing pin-point tenderness and slight swelling. Grade 2 Turf Toe consists of partial tearing of the ligaments which causes widespread tenderness, moderate swelling and bruising. Movement of the big toe is limited and painful in grade 2. Grade 3 is the most severe and involves complete tearing of the ligaments resulting in severe tenderness, swelling and bruising. In grade 3 Turf Toe it is painful and difficult to even move the big toe. Symptoms of Turf Toe include:

  • Pain and tenderness in the ball of the foot and the big toe
  • Swelling and bruising of the ball of the foot and the big toe
  • Inability to bear weight on the ball of the injured foot
  • Inability to push off on the big toe
  • Reduced range of motion in the big toe

Treatment of Turf Toe

Depending on the severity of the injury, treatment strategies can vary. In a grade 1 Turf Toe injury the RICE (rest, ice, compression, elevation) protocol is recommended. Taping of the big toe or use of a stiff orthotic can also be used to prevent the big toe from going into hyperextension.  With a grade 2 injury, an individual may be prescribed a walking boot for 1-2 weeks after the injury.  RICE protocol should also be used in a grade 2 injury.  A grade 3 Turf Toe injury may require surgery to repair the soft tissue and ligaments that were injured.  An immobilizer, such as a walking boot or cast, will be used in a grade 3 injury.

Physical therapy is recommended with all grades of a Turf Toe injury and should be started as soon as symptoms allow. Physical therapy is essential to facilitate early movement of the big toe to prevent joint stiffness and scarring. Physical therapy will also include strengthening and stretching interventions the entire lower extremity.

When treated early, Turf Toe injuries tend to heal well. Mild to moderate persistent symptoms are the most common complication. Potential long-term complications include lack of push-off strength, stiffness, bunion, and locking up of the big toe.


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