Turf Toe is a painful condition caused by damage to the structures around the big toe. It is caused by hyperextension of the big toe (when the toe bends back too far).
The medical term is a metatarsophalangeal joint sprain. It most commonly affects athletes playing on rigid surfaces such as artificial turf e.g. American football, soccer and basketball players, but also affects other athletes including gymnasts, ballerinas and wrestlers.
It results in pain, swelling and stiffness around the big toe. If left untreated, it can cause long-term problems. Here we will look at the causes and symptoms of turf toe, how it is diagnosed, the best treatment options, the prognosis and recovery process and how to prevent it.
If the big toe gets bent back too far, the ligaments and/or the joint capsule underneath the big toe get over stretched. This often happens if you are tackled from behind or fall forwards and the foot stays flat on the ground. Pain develops immediately and tends to get worse over the next 24-48 hours.
Turf toe can also develop gradually from repetitive, forced jamming through the big toe such as with quick pivoting, accelerating and jumping. When this is the case, the symptoms develop slowly and increase over time.
Playing on artificial surfaces rather than grass increases the chance of developing turf toe as the ground is harder and less flexible, putting more pressure through the toe. A study in the American Journal of Sports Medicine looking at professional football players suffering from Turf Toe showed that eight three percent of them played on artificial surfaces.
Flexible foot wear can also increase the risk of developing the condition. Shoes that are flexible provide less support and allow the toe to hyperextend.
Your doctor can usually diagnose the condition from what you tell him about how the injury occurred, the sports you play and your footwear. He will examine your feet and may order an x-ray to check for signs of any damage to the bone, from either a fracture or arthritis.
The aim of treatment is to reduce pain and inflammation, and protect the
joint from further damage. The acronym PRICE stands for Protect, Rest,
Ice, Compression & elevation and is the best first-line treatment:
1) Protect: To protect the joint from further damage you should stop playing sport immediately
2) Rest: The joint will need time to recover so you will need to rest from sports for a few weeks. You should avoid activities where you push through your toe such as running, and you may need to use crutches initially so you aren’t putting any weight through your foot at all when walking. In severe cases, you may be given a cast or special walking boot that stops the toe from moving altogether
3) Ice: Regularly icing the joint helps to reduce inflammation. Find out how to safely and effectively use ice in the Cold Therapy section
4) Compression: You can help reduce further swelling by wearing a compression bandage like tubigrip
5) Elevation: keeping the foot raised higher than the level of your heart will help to reduce swelling
Other things that can help include:
1) Strapping: it can help to strap/tape the big toe to the second toe to limit movement and reduce stress on the big toe
2) Anti-inflammatory medication: your doctor may advise a non-steroidal anti-inflammatory (NSAID) such as ibuprofen to help relieve the inflammation
3) Physical Therapy: Mobilisations and exercises to stretch and strengthen the big toe will help prevent any long-term stiffness developing
4) Surgery: in severe cases, surgery may be required e.g. if a bone spur has formed which limits toe movement
The best way to prevent Turf Toe is to wear stiff-soled shoes (e.g. containing a metal plate) that prevent the toe from bending too much. You can also get special cushioned inserts that can help. Many athletes also tape their toes to keep them from bending back too far.
Playing on grass rather than artificial surfaces also helps reduce the risk as it is softer and absorbs shock better.
It usually takes three to four weeks to recover from Turf Toe, during which time complete rest from sport is required. It is really important to rest properly and not to return to sport too soon. If you keep aggravating the joint, the ligaments/capsule will not heal properly and recovery will take much longer.
Athletes who do not rest properly or address the cause of their Turf Toe are likely to develop long term problems such as arthritis and stiffness in their toe.
There are a number of other causes of toe pain. If this isn't sounding quite like your problem, visit the toe pain section. Alternatively, if you want help working out what is causing your pain, visit the foot pain diagnosis section.
"Thank you so much! Your website is a
fountain of information! I was worrying about top of foot pain, and
your suggestions for strengthening and stretching are helping
"Your info took me straight to the problem. Well described and clearly explained."
"Thanks for having these exercises available! I performed a few and they have helped tremendously with my foot pain."
"Thank you for this information, it is very useful."
"Some really good suggestions and information"
"I have suffered these symptoms for over a year seen two doctors and a physio. None of them diagnosed this. Hope its not too late to put your advice into practice." Lezlee, UK
"Certainly it has helped me to understand and educate me on the issue."
"Very interesting! All good information. Tried a few stretches, already feels good."