Turf Toe | Orthopaedics | Loyola Medicine

Turf Toe

Overview and Facts about Turf Toe

Turf toe describes any soft tissue injury in the plantar complex and usually involves a sprain to the big toe’s main joint. Turf toe, an orthopaedic condition, results when the toe hyperextends — an example is when a person pushes off the ground into a sprint. The repeated force behind the hyperextension and the bending of the toe will increase the risk of turf toe.

The condition can cause damage to the big toe ligaments, plantar plate, or soft tissue and can even displace the joint itself.

Signs and Symptoms of Turf Toe

The signs and symptoms experienced with turf toe determine the severity of the condition.

  • Grade 1 — Symptoms include points of tenderness and mild swelling that result from soft tissue stretching.
  • Grade 2 — Symptoms include tenderness around the big toe, moderate swelling, and bruising. The toe’s range of motion is limited and moving it results in pain.
  • Grade 3 — Symptoms include severe tenderness, extreme swelling, and significant bruising. Moving the toe is difficult and painful. Grade 3 injuries often involve tears in the soft tissue.

Causes and Risk Factors of Turf Toe

Turf toe typically results from engaging in sports activities. The injury is caused when the big toe hyperextends with the toes on the ground and the heel raised.

The highest prevalence of turf toe is among American football players who practice and play on artificial grass, or turf. Artificial turf is harder and less shock-absorbent than traditional, grass-covered football fields. To complicate matters, turf shoes are soft and flexible, sacrificing stability in the forefoot for increased agility.

In addition to football players, other athletes with an increased risk of turf toe include:

  • Wrestlers
  • Soccer players
  • Basketball players
  • Gymnasts
  • Dancers

Tests and Diagnosis of Turf Toe

A doctor can diagnose turf toe after conducting a physical exam and potentially ordering imaging tests. During the examination, the doctor asks questions about symptoms, when they started and what, if anything, relieves the pain.

They look at any swelling and bruising and also test the toe for range of motion and stability. They may compare these symptoms with the other big toe.

If necessary, the doctor may recommend imaging tests to confirm or rule out other conditions.

Treatment and Care for Turf Toe

In mild to moderate cases of turf toe, doctors often recommend treating the toe using the RICE method: rest, ice, compression, and elevation. For pain and swelling, they usually suggest using over-the-counter, anti-inflammatory medications. Stiffness can be addressed with stretching and strengthening exercises.

The doctor may also recommend switching to a stiff-soled shoe or wearing an orthotic, such as a shoe insert, with a rigid forefoot component, especially when playing sports.

In more severe cases, the big toe joint may require immobilization with a walking boot or taping regimen. In these cases, physical therapy can also help.

Although rare, some extreme cases require surgery to restore athletic performance. These surgeries are highly customized to the individual’s specific needs.