Turf Toe | Causes, Symptoms and Treatment

Any athlete, football player or avid sports enthusiast is likely to shudder at the thought of developing turf toe. The injury is common with sportsmen, especially those who play on Astroturf and synthetic surfaces. Turf toe is an injury which affects the big toe, and is caused by damage sustained to the soft tissue around the first joint in the toe; medically known as the metatarsophalangeal joint.
The injury is actually a sprain of a ligament at the base of the toe which is responsible for moving the big toe up and down. The injury is sustained by a hyperextension of the big toe, or to put it simply, over stretching of the ligament. The injury can cause intense, sudden pain which is enough to take you out of the game. It is also likely to take some time for the ligaments to heal, with the recovery time typically 2-3 weeks.
While many muscle, tendon and ligament injuries develop over time due to repetitive strain, turf toe is usually caused by a single trauma. This can be because of a sudden movement, a heavy tackle or fall or simply catching the toe awkwardly when running. Typically this occurs when the big toe remains flat on the turf during a forceful activity and is bent excessively as the body weight is exerted on the toe. While turf toe can affect any toe joint, it is almost always the big toe which suffers from this type of injury. The reason why turf toe is commonly linked with artificial playing surfaces is because the surface yields much less than grass, and causes excessive force to be exerted on the toes. Turf toe can also be caused by running barefoot or walking or running in shoes with soft soles with scant cushioning under the big toe.
A turf toe sprain is often accompanied by a partial dislocation of the joint, with many sufferers able to feel or even hear the big toe click or pop when the injury is sustained. The injury is usually accompanied by considerable pain in the joint, the base of the big toe often becomes swollen and weight bearing may not be possible without intense pain. Pain is at its greatest when trying to flex the big toe upwards.

Turf Toe Treatment

As with any ligament strain the best treatment for turf toe is to ice the area immediately. Ice has three effects on the injured toe and joint. First and foremost the ice will restrict blood flow and reduce inflammation. Fluid build up will be limited to keep swelling to a minimum level and ice also acts as a painkiller. An ice pack should be applied for 15 minutes at a time to reduce the chance of skin damage.
Ice is part of the RICE treatment regimen, with the R standing for rest from activity, C for compression and E for elevation, and all four treatments are highly beneficial as a primary treatment for turf toe. Compression, from a bandage for example, helps to reduce swelling and fluid build up. Elevating the affected foot also serves this purpose. While some people believe heat treatment to be effective for this type of injury, it can have a detrimental effect on the toe. Heat has the opposite effect to ice and increases blood flow, promotes swelling and may therefore increase the pain suffered.
Following administering RICE treatment a doctor should be consulted to assess the damage caused. A doctor will typically call for an X-ray, and while this will not diagnose turf toe, it is used to rule out bone fractures. Typically this type of injury can only be accurately diagnosed by a bone scan, CT imaging test or MRI. Due to the expense of these tests they are usually reserved for sportsmen when the cost justifies the means. In most cases a turf toe diagnosis is confirmed by a physical examination and case history of how and when the pain started.
Turf toe will typically cause pain for 2-3 weeks following the injury. Pain can be controlled by NSAID’s such as Ibuprofen, or in extreme cases a corticosteroid injection may be recommended. All weight bearing activity should be stopped for around 4-5 days following the injury to prevent further damage being sustained. A brace or splint can help to keep the toe in the correct position while healing takes place, with the use of a crutch oftentimes recommended.
Depending on the severity of the injury it may be necessary to undergo physical therapy to improve movement in the toe and build up strength in the affected ligament. Ultrasound and electrotherapy can be beneficial for treating turf toe, although simply resting and supporting the toe during recovery may be sufficient.