Turf Toe

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Turf toe is a term that’s thrown around a lot in professional sports, especially in the NFL, but what exactly is it? Does it only occur when playing sports on turf? Why does a toe injury keep players out of action so long? What athletes are at risk for turf toe? I’ll try to answer a few of those questions and more today.

Turf toe is a hyperextension injury of the great or big toe. The hyperextension causes a sprain or tearing of the ligaments and joint capsule on the undersurface of the metatarsal-phalangeal (MTP) joint. Severe cases can cause a complete tear of the joint capsule of the bone and result in a subluxation or even dislocation of the MTP joint. The sesamoids, the small bones encased in the flexor tendons that travel under the MTP joint, can be fractured in some cases of turf toe which adds not only to the pain of the injury but also to the recovery time.

Turf toe gets its name because it is a very common injury in field sports played on hard turf. Cleats/turf shoes tend to stick to the surface more, making a hyperextension injury more common. Very flexible shoes, like those worn by most soccer players, can add to the risk of injury. Football players are prone to this injury for the same reasons as other field sports, but they also have the added risk of the foot being planted and another player landing on the leg, forcing the toe into hyperextension.

Shoes with a more rigid forefoot that prevent excessive motion can help reduce the risk of developing turf toe. Taping techniques can also help limit the amount of MTP extension of the toe and can help prevent turf toe. Some players, especially those with a history of turf toe injury, can wear a rigid insert in the shoe that limits toe extension even further, but these sometimes can limit the amount of push-off force that can be achieved and may reduce speed and power.

Treatment of acute turf toe injuries starts with the RICE protocol of rest, ice, compression, and elevation. An oral-inflammatory can help reduce the initial pain and inflammation as well. A period of rest to allow the ligaments and joint capsule to heal is required, which varies on the severity of the injury but averages 3-4 weeks. Shoe modifications or inserts as discussed above in the prevention section are important in the initial treatment and during the return to sport to prevent re-injury. Returning to play too soon from a turf toe injury may result in chronic damage, which can lead to chronic pain and ultimately osteoarthritis of the MTP joint.

Even though it gets a lot of publicity in football and field sports, turf toe is also a common injury in another set of athletes. Ballet dancers rely on hyperextension of the MTP joint for many of their positions and landings. While they can get acute turf toe injuries, chronic sprains are more common in this group. Treatment is generally rest, as they usually cannot perform while wearing rigid shoes or inserts.