Spring sports season is here, which means athletes involved in sports like baseball, softball, track and field, and soccer have started regular practices and work outs. When training for these activities intensifies, sports injuries occur more frequently. One of the more common injuries we see this time of year is one you may have heard referred to as “turf toe”. Turf toe is a term that describes a sprain or partial tear to the ligaments and supporting structures around the first toe joint. This injury acquired the name turf toe because it began occurring as artificial turf became a more common playing field. Even though it’s linked to fields with artificial turf it can occur on soft grass or any playing surface. In our office we see it across the board in any sport that requires pushing forcefully off your forefoot – which is almost all of them!

What are the symptoms of turf toe?

  • Pain at the base of the big toe, which is usually sudden onset
  • Tenderness to touch or pressure at the big toe joint
  • Swelling of the big toe or the area just behind it
  • Decreased motion at the big toe joint
  • Pain that worsens with increased intensity

How is turf toe diagnosed?

Turf toe is usually diagnosed based on the symptoms of the patient, and a description of how the injury occurred. Occasionally the patient will describe having heard or felt a pop at the joint. More often they describe a sudden intense pain at the joint with an inability to put pressure through the toe joint. In most cases an x-ray will be ordered to check for fractures of the bones around the joint. Occasionally an MRI or CT scan can be ordered for a more detailed visualization of the injury.

Once diagnosed, turf toe is graded based on the severity of the injury and the degree of damage that occurs to the ligaments and joint capsule. Injury can range from a mild stretch to a complete tear.

  • Grade I: stretched ligaments and joint capsule
  • Grade II: partially torn ligaments and capsule
  • Grade III: complete tear of ligaments and joint capsule, with possible joint dislocation

How is turf toe treated?

Initially, treatment consists of rest, ice, elevation and possibly an anti-inflammatory medication. Your doctor might recommend a walking boot or stiff-soled shoe to immobilize the joint, allowing the tissues to heal. Once the pain and swelling have improved, physical therapy is often recommended to stretch the first toe joint with range of motion exercises. This is an important part of treatment because it can help prevent a form of arthritis called hallux rigidus. This condition leads to the joint being permanently stiff with decreased range of motion and possibly chronic pain. Occasionally, in very severe injuries or injuries that do not improve over several months, surgery may be necessary to repair the damaged tissues. Surgical treatment would also mean a period of non-weight bearing to the injured foot for several weeks.

What happens when I return to my activities?

Once your doctor has decided it’s okay for you to return to your activities, you will want to take it slow. Returning to activities after an injury should be done gradually. As always, it’s very important to stretch and do a light warm up before participating in any strenuous activity, but it is even more important after a turf toe injury!

How can I prevent turf toe from happening?

Turf toe is known for being a nagging injury that can take several months to heal enough to where you are back to full speed. You should always wear appropriate and supportive shoes during any physical activity. Wear inserts or custom orthotics as recommended by your doctor if you have a gait abnormality. If your sport requires a cleat, never use a tennis shoe while engaging in the activity, as they are less rigid in the forefoot than a cleat which increases the risk of injury. Your physical therapist or doctor can also teach you how to tape the big toe to limit motion at the joint during activities. Taping is particularly helpful if you’ve suffered this injury before and want to avoid a repeat. Also, training on soft grass fields is safer than training on harder surfaces. Athletes with a history of turf toe are known for re-injury, so if you’ve had one, you’ll want to take these precautions. Be sure to come see us at FAANT if you are dealing with a turf toe injury. We will get you back to the activities you love!


This article was featured on Southlake Style!

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